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

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In this video, Dr Sanjay Gupta discusses the subject of ablation for atrial fibrillation and what factors people should think of when they are considering an ablation. My name is Sanjay Gupta. For more information visit me at http://yorkcardiology.co.uk ====================================================== Please click below to subscribe for more videos http://www.youtube.com/subscription_center?add_user=YorkCardiology ====================================================== You can also find me on: Facebook https://www.facebook.com/yorkcardiology1 Instagram https://www.instagram.com/yorkcardiology
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Текстовые комментарии (243)
SENTHIL NATHAN S (8 дней назад)
Thanks a lot!
King of slots MILLION (23 дня назад)
what is the person has an irregular rhythm and 160bpm heart rate at the same time. That's what going on with me now
Abbi Cat (23 дня назад)
I have atrial flutter and ventricular bigemy and inappropirate sinus tachycardia ...i have like no quality of life .. i cant even put my pants on im so breathless ... im seriously considering the ablation
renee sam (29 дней назад)
Thank you dr. You are so smart
jan shifferd (1 месяц назад)
I will see an electrophysiologist today an I have read so much in the last months that I am now scared an all mixed up as to what choices to make. As as a retired Respiratory Therapist I have enough knowledge to be dangerous to myself. Thank you for your calm approaches to afib and I hope I will make the right choice. I don't want to take anti rhythmic drugs.
York Cardiology (1 месяц назад)
best wishes Jan
Pablo Padilla (1 месяц назад)
Love it!
York Cardiology (1 месяц назад)
Thank you so much. I am also now doing short vids on Instagram as 'YORKCARDIOLOGY' and on facebook as '@yorkcardiologist'. Please consider subscribing and sharing:-)
Ididntdoit 1984 (2 месяца назад)
I was 61 Years old when I had a cardiac ablation procedure for Atrial Fibrillation at University of Washington Medical Center in Seattle Wa. It was 100% successful. I'm 66 years old now and have had no problems since. My electrophysiologist said absolutely nothing about remaining on blood thinner for life as the Dr. in the video suggests. As a matter of fact, he told me that it would fine if used an 81 mg aspirin after 3 months. Be sure to get more than one opinion when considering ablation for Atrial Fibrillation. Don't be too afraid of it. The Dr. here is in the U.K. Keep in mind when viewing this video is that health care in the U.K. is somewhat rationed. Don't take my word for it, but think about why the good Dr. seems overly cautious.
York Cardiology (2 месяца назад)
I think the reason they didn't recommend anticoagulants after the ablation was because your CHADS2vasc score was very low to start off with and therefore you didn't need anticoagulants anyway. if your chads2vasc score was higher then most docs would recommend continuing
Katie Hall (2 месяца назад)
Hi Im 54 years of age and are currently been treated for paraoxysmal Fibrilation and have been for the past 5/6 years. I was due to have 2 CT scans which i was unable to have on both occassions as my obs were very high and they were unable to regulate for the CT scan to tke place even with 3 additional doses of bisoprol which had no affects I was so ill on the day of my 1st scan that I ended up in A& E for 12hrs. Im already on flecanide and bisoprol but having no affects now as keep going into AF for long periods now. and affecting my breathing and very poor energy levels worsened too As I have very little energy daily tasks have become increasingly more difficult. My heart consultantant has referred me to another specialist to have these proceedures done and possibly have to have a pace maker so your video has been very informative and helpful in so much that i can do my part in making me as healthy as possible to support their treatment and care of me. I have major concerns in regards to my weight which I have raised for this past 2 years and have gained considerable weight recently as been so ill and innactive due to symptoms and breathlessness which has been a big concern to me. sos thank you for all this invalueable advice. Its much appreciated
Allison Sheppard (2 месяца назад)
Hi please get back to my comment as soon as possible. They don’t exactly know what’s wrong with me. They know I have SVT and possibly atrial flutter. They said they will be doing a test while I’m under and then decide whether I’ll get the full ablation done. Ifs it not one of the three things then they won’t. This is on Thursday!! Oct 4th. I’m only 21, I’m not overweight. I’m honestly just really scared. I’ve read up on it, and I’m not looking forward to the chest pain and other symptoms. I hate going through my episodes where my heart rate gets up to 180 and my chest pain is unbearable. My cardiologist highly recommends the ablation though, since I’m only 21 he doesn’t think I should be on medication for the rest of my life because he says it’ll eventually stop working. Idk what to do. I’ve talked to two different doctors, and they both recommend it.
York Cardiology (2 месяца назад)
SVTs are not uncommon in the young and healthy and an ablation for SVT (this video is about ablation for AF not SVT) is an exceptionally effective treatment which offers you a cure (not just symptom control but a cure)
Don Wetherell (2 месяца назад)
https://youtu.be/KeKelRpEgdI I will try and get some scientific peer reviewed papers from these MDs. I know that nutrition isn't really taught during medical training but this is a great video to watch by these doctors that have researched for decades about heart disease and have been reversing it for decades.
Don Wetherell (2 месяца назад)
Do you not think that eating more whole foods and cutting out processed foods and drinking more water would be a safer way to thin the blood? Rather than taking pills?
York Cardiology (2 месяца назад)
why do i want to thin the blood? i want to prevent strokes.. i don't care whether that is achieved by thinning the blood or not.. if you can show me some robust scientific evidence that your method prevents strokes (rather than thinning blood) then i am all ears.
Don Wetherell (2 месяца назад)
https://www.youtube.com/watch?v=yjRqpwmRuts Take magnesium supplements.
Grace Clermont (2 месяца назад)
I guess i was very lucky i had one done in Canada in 2005 and it work very well for me .
Dan R (2 месяца назад)
I will say that I feel much, much better off of all BP and heart rhythm drugs. I really do not think "the doctors" have this figured out yet and patients are in the same class as guinea pigs.
Mannington Villavicencio (2 месяца назад)
What if I’m both out of rhythm and fast rate according to stress test. Then ablate? I’m paroxysmal and been on Flecainide for 6 years now. Thank you for your reply.
Eileen White (3 месяца назад)
Hi doctor, does seizures occurs with sleep apnea and Atrial fribulation.
Inca Warrior (3 месяца назад)
Thank you so much, really helpful, doctors here in Miami make it sound is really easy, but now I think I don't really need it.
kpa kpa (3 месяца назад)
Dear Dr Gupta, Thank you for a very informative video. Perhaps you can elaborate on what is likely to happen to the heart long-term when AF is controlled solely by rate control (beta blocker): I am 60 years old and have a normal BMI. Paroxysmal AF (vagally mediated) started approx. 2 years ago. Up until 6 months agao I was able to reliably terminate these AF episodes by exercising and/or performing a modified Valsalva manoeuvre. However, I have been in AF continuously for the past 6 moths. I am moderately symptomatic. I have had two cardioversions, both on amiodarone (200mg). In the most recent I converted on the third attempt but reverted back to AF after a few minutes. Echo study showed that I have mild bi-atrial dilation and mild mitral and tricuspid regurgitation. Ventricular structure and function are normal. I am now considering catheter ablation and ideally would like to establish the chance of success and weigh this up against the option of remaining on rate control. Currently 5 mg bisoprolol is controlling my pulse rate at below 90 bpm. I understand that with rate control it is only the ventricular rate that is controlled and the atria continue to fibrillate at a very rapid rate. I have been unable to find relevant studies to establish what would likely happen in the long term (5-10 years) if I rely solely on rate control. I quote from an online article by a well know American Cardiologist: “… for the patient with persistent AF there is a penalty for allowing continuous AF, because after 2-3 years you won’t be able to successfully ablate it. In the past, we left patients with asymptomatic AF that way for the rest of their life, but now we know that if patients remain in AF over time, they will lose the option to have it ablated, and their risk of stroke, dementia, and heart failure will increase.” The above article does not refer to any published studies. Is it inevitable that further adverse structural remodelling will occur and if so over what timescale? Will the risk of stroke, dementia, and heart failure likely increase with time while the ventricular rate is adequately controlled? I have read that in some cases reverse structural remodelling takes place after a successful ablation. For example, the atria revert to normal size. Is it possible to identify patients where beneficial reverse remodelling is likely to happen? Thank you in advance for considering my questions.
York Cardiology (3 месяца назад)
Hi Kpa.. the AFFIRM study showed that there was no significant diffeence in outcome between a rate controlled strategy compared to a rhythm control strategy:-)
djs2356 (4 месяца назад)
The question is: Was the ablation *Truly* successful????
scruffle (4 месяца назад)
what happens if you can't take anticoagulants because of another drug you take? what would one do to get rid of afib?
Adifah S. (4 месяца назад)
Its best to go all natural with Wpw. no pills needed...
Nick Fitzer (17 дней назад)
Adifah S. What symptoms do you suffer from with WPW
tony goss (5 месяцев назад)
O
Lucky 1038 (2 месяца назад)
Thank you again and again for producing these wonderful videos and for being extremely generous with your time taken to help people. Recently I was put on Tikosyn for 2 days and the 3rd day i had cardioversian - which put me in sinus rhythm but it only lasted for 10 hours. after that the cardiologist put me on amiodarone -- started w. 400 mg 2 x a day - then 200 mg twice a day for 2 weeks and now i'm taking 200 mg. once a day. i was in sinus rhythm for 2-3 days but when i went home i was back with Afib. the doctor wants me to wear a heart monitor for a week to see how long and how frequent the Afib occursl
TheKetch35 (5 месяцев назад)
What can u use instead of amiodrone since it is toxic if taken for long.
Jay the magyar (5 месяцев назад)
Thank you, Doctor.
Shyam Parikh (5 месяцев назад)
Thank you for your video. It was very informative.
Clint Harris (5 месяцев назад)
Dr. G, I've had 2 ablations and 3 cardio-versions. I'm 60 and in otherwise great health apart from the Afib / Aflutter, which comes and goes. I am scheduled for THORACOSCOPIC ABLATION SURGERY next Monday. Entry through both sides of the chest. Any study I can find shows that this is less successful than ablation alone yet with more complications. Any input on this topic?
Sheila Smith (5 месяцев назад)
You say A fib is end product of inflammation. I agree with you but HOW does one determine the etiology of their inflammation? I've often felt stress, lack of physical exercise, poor diet and insufficient dietary minerals was a key to this. After addressing and ruling out sleep apnea, marked weight loss and engaging in daily exercise, my patient elected to have the ablation. He's 7 months post ablation with no relapse and down to only taking metoprolol. I've prescribed what I've researched and believe to be the best Nutraceutcals which includes Pro- Multi Plus a very potent multi vitamin and mineral supplement, Optimal EFA's, CoQ 100, & 400 mg of Magnezyme per day. All products by physician only prescribed Nutraceutcals by Biotics Research Corp. He's stable and has gone from a severely stressful executive job with Medtronic to working physically as a boat/yacht detailer! His stress levels have decreased exponentially and he feels freedom in his life finally, from corporate stress! It's been my experience as a Nutritional Therapist that poor diet, stress and lack of physical exercise go hand in hand with so many heart conditions (as well as OTHER conditions)! I contend the lack of minerals is a major factor contributing to electrophysiology problems of the heart! Could you please comment? Bless you for your much welcomed and needed contributions to the world with your videos! I wish you'd come to lecture in Minneapolis/St. Paul, Minnesota!
Sethos (5 месяцев назад)
I went through 3 ablations that completely sent my afib over the edge, to a point where I could barely live any more. Those ablations did far, far more harm than good. It was so bad, I opted to have a cut-and-sew maze just to get some semblance of a life back. So while ablations might be all the rave in afib / ectopic circles, they can absolutely also have a dark side.
Uma Anand (5 месяцев назад)
What about for the pt.with STV conditions,will you be kind enough to make the video about in and out of this condition.I love your work .These videos are very educational .I love to watch all your videos.God bless you .you are the best doctor.
Hemant Rishi Damera (5 месяцев назад)
Very useful analysis to get an idea prior to have ablation!
York Cardiology (5 месяцев назад)
Thanks Samuel!
Gregory T Barrett (6 месяцев назад)
I have been diagnosed with AFIB since 2007 ,I had a cardioversion which kept my heart in rhythm for 5 years when the AFIB returned I changed my diet and lifstyle 360 which has helped my lifestyle tremendously. I am active playing basketball and cycling and working out with AFIB. I will go for another cardioversion again and keep to the diet whichmakes me feel great. Good Luck everyone. Good Health.
John Sawdon (6 месяцев назад)
I had my ablation at St Michaels which returned me to natural rhythm . I was awake and felt pain when the burning occurred and was told not move. When I exercise aggressively, especially if under stress, I occasionally spike in terms of heart rate. It only lasts a minute but can rise to 190 . My ablation was in 2009 . I developed both Atrial Flutter and atrial fibrillation during my bypass surgery in 2007. So far so good
Lion City Management (6 месяцев назад)
This guy speaks to me more than my doc! Thanks you have on several occasions gave me the answers I need! 5 years into paroxysmal afib an I do want a better quality of life, having this sux!
IrishBoson (7 месяцев назад)
What do you consider a "natural treatment" in western medicine? Are not all pharmacological derived medications and procedures unnatural? Still yet they benefit people everyday despite side effects and risk. What about young people in their 20s-40s with non-symptomatic paroxysms of afib that failed anti-arrhthymia medications and are considering ablation? Looks to me from the literature that afib causes significant scarring/damage in the heart. The disease also progressive. Wouldn't a successful ablation prolong life for those folks regardless of their CHADS2VASC score ? Thanks
SPQR (8 месяцев назад)
What is a "consulting" cardiologist?
Tani Popov (9 месяцев назад)
Hi I was diagnosied with AVNRT. My echo does not show any structural changes. However in a normal state my ecg is showing some small deviations which  apear in a normal state ( when i am not having the AVNRT). Is this AVNRT related? Thank you in advance.
joseph wall (9 месяцев назад)
Dr. Sanjay Gupta, Is there a safe coagulant that you recommend?
MrJasonChheda (9 месяцев назад)
In regards to being on an anti-coagulant ( blood thinner) after having an ablation, generally patient's are still on these meds for 2-3 months. After that, the decision on whether or not it is still necessary to continue a blood thinner is determined by the patient's overall stroke risk. This is calculated by a patient's CHADS2VASC score. Dr. Gupta is correct in saying that getting an ablation does not mean you can be guaranteed to stop your blood thinner. That decision still depends on your stroke risk
Maya Lauzon (9 месяцев назад)
How bout 265 a minute?
Maya Lauzon (9 месяцев назад)
I'm going for my second ablaze. I'm 36. Are you saying that this is a mistake. I should live with a fib?
Red Burtley (9 месяцев назад)
Great video! Too many videos on YouTube by people (actual patients) advocating getting ablation done. I relived 80-90% of my symptoms just by improving my diet and taking supplements. Ablation sounds pretty extreme.
Quila Bell (9 месяцев назад)
You will NOT require anticoagulation therapy life-long after a successful ablation. You will not require any meds after a successful ablation given no other co-morbdities that would require these therapies. This guy is completely wrong and needs an update regarding latest studies and patient outcomes. You will obviously remain on all of your meds during the blanking period, and possibly months after depending on what the loop recorder shows, but if you are completely A.Fib free at the end of 6 months you are weaned off all meds. This is standard of care. Are you really an EP?????
Lesley 61 (3 месяца назад)
Could you please give me your thoughts on cyro ablation . I have had afib for years. Medication does not fully control it. I am trying one last medication before i consider resorting to ablation.
Tony M (10 месяцев назад)
FOLKS :I don't wish to single anyone out, so here goes. all over YT folks abuse the English language ,who are usually otherwise often articulate. ''would of done ''is not in the English language .'would've' o'r would have' ,is the correct way to write it..
Tony M (9 месяцев назад)
yes, Alistair Simpson. lots of us Yanks are out of shape AND illiterate.
Alistair Simpson (9 месяцев назад)
Tony M but they should be out doing exercise not sitting on their arse.
Tony M (9 месяцев назад)
I hope you do enjoy good health, but folks do this only because they don't read enough which they can do sitting on their asses.
Alistair Simpson (9 месяцев назад)
Tony M That's one of the main concerns for people considering an ablation 😂 shoulda woulda coulda
Nichelle Rieber (10 месяцев назад)
Is it possible to get an ablation or an eps done while sedated?
Currency49495 (10 месяцев назад)
My cardiac electrophysiologist recommended this surgery for me recently. I'm 33 years old now, had pacemaker surgery Dec 6th and currently in AFib 15 hours a day. However I can only feel it when going into a resting state, i.e. going to lay down at bedtime. I take low dose Aspirin daily and have little issue with that, I however don't want to be on medication for AFib the rest of my life nor am I looking forward to a surgery every 1-3 years for the rest of my life. I slept 15 hours yesterday, Saturday and had no issues going to bed at my normal bedtime. I'm a machinist by trade, and have not seen any issues with working 9-10 hours a day five days a week. I have heard it could be an issue but I've not experienced any. Also not noticed much of a difference in day to day activity since surgery in Dec. I live in Indiana, USA, and plan to seek a second opinion on my AFib otherwise I'm ready to schedule surgery.
Nichelle Rieber (11 месяцев назад)
I was recently told an ablation would be the best thing for my PSVT that has been ongoing for 6 years. I tried beta blockers when I was younger, but they made me feel tired, dead, and have no emotion. I'm not even worried about the actual surgery itself, but I am terrified of waking up sick. I already have a sensitive stomach but was wondering is there anything I can do to help before hand? Is there something I can ask my doctor to help out with this for when I wake up. Every other time I have been put under I have woken up with shaking. Just nervous I guess.
Nichelle Rieber (11 месяцев назад)
York Cardiology i appreciate the quick response, thank you.
York Cardiology (11 месяцев назад)
they could give you some sedation tro calm you down
steve teager (11 месяцев назад)
Hi I'm a 58 year old male had 2 ablations for RVOT ectopics in 2015 6 months apart. I believe this has caused my cardiomyopathy and heart failure. It has made my life a misery. Think very carefully before you sign the consent form.
BONNIE ATKINSON (1 месяц назад)
steve teager !
carl sandino (1 месяц назад)
steve teager
Ricky R (11 месяцев назад)
hi Doc! can you tell me if there's any chance to make an cryoablation in a girl with ventricular displasya?, she had a RF ablation but didn't work, and know she's gonna have another RF but I told her that she.can try with cryo
Hector F. (1 год назад)
So if you have a defibrillator already, do you need an ablation? Will that make the defibrillator work more?
York Cardiology (11 месяцев назад)
Thank you so much for your comment and for watching the video. Please join me for live free chats on my Facebook page (type yorkcardiology@gmail.com in Facebook search) - I will be able to answer your questions there
Nikpeegee (1 год назад)
Thanks again Dr. Gupta - very helpful. I had an elective cardio version recently which was unsuccessful. Therefore I am still in AFib with a heart rate controlled by Bisopralol. I have a consultation next week with an Electrophysiologist to explore ablation as an option. Because I have had an unsuccessful cardio-version, is cardio-version likely to be ruled out as a means of treatment again?
Brenda Neelands (1 день назад)
Nikpeegee how are you doing now? What did you end up doing????? I’m in the same boat right now.
Piroska Merk (1 год назад)
Hi Dr Gupta. I just hade a Atrial Ablation 3 months ago sadly it’s isn’t help me My condition it’s worsened. Right now I having Atrial flutter. I get medication but not really helping me. I was told had to have a another Ablation. A m so confused. My life is now in and out of the hospital a last 3 month I passed out 3 times it’s happened one day 2 times also my blood pressure is sometimes higher sometimes very low. A m scare now. Thank you for your useful video. 🤗
Stuart Parker (1 год назад)
They freeze now not burn
Deborah Unger (1 год назад)
I had a paroxsymal afib. The longer I took meds to minimize the awful 8-hour episodes that arose out of the blue and not due to exercise or any other reason, the more my liver numbers increased. That worried me. And when I was seen in an Urgent Care while in afib, I ended up in an ambulance and the ER, against my wishes. There, because my b/p is so low, the Metropolol they gave me sent me into la la land. I ended up in the ICU. There my rate was so out of control they gave me a bolus of amiodarone (YUK!). That was enough for me. I had an EP I trusted and eventually agreed to the procedure -- a cryoablation. Took Xaralto for one month afterward and after that, I was done. That was three years ago and no return of symptoms and no meds. He even released me from the annual check-ups because I've done so well. I learned about magnesium more than two years ago and supplement with it. Been doing great. So I would say quality of life was my reason for having the procedure. I love not being suddenly overcome with 8 hours of 157 bpm. Now my rate rarely exceeds 60. BTW, your videos are wonderful! Thank you!
Jeanita Sykes (8 дней назад)
Thank you for sharing your testimony of afib ablation. I have been diagnosed with PAF as well and scheduled for cryoablation as well. I am 49 and pray that I will be able to return to a normal quality of life. Your story inspires me.
rsully21 (1 год назад)
Could you to an overview comparing and contrasting ablations with the new mini-maze procedure and the hybrid treatments? Thank you!
rsully21 (1 год назад)
Dr. Gupta: Thank you for posting these excellent videos!! I appreciate you time and insight. Unfortunately, I am one of those with debilitating AFIB, and have addressed lifestyle to the best of my abilities - and have had two unsuccessful ablations. My question: You mention reducing inflammation. How to measure inflammation, CRP test? (Mine came back normal.) How to reduce inflammation? Thank you!
caroline whyman (2 месяца назад)
Although I am not a doctor or physician of any sort I have recently listened to many lecture series on the internet and one of the recurring things I hear is that the major causes of inflammation are WHEAT and SUGAR. I am addicted to sugar and wheat and have just gone a week without and already feel less agitated and less bloated... maybe give it a try and research alternative health sources on youtube?
Nicholas Mills (1 год назад)
Dr.G, I agree with you. Everyday people are uneducated and run for these procedure without noting that the success rate is low. Please people consider your options and maybe even go see a cardiovascular surgeon for consultation regarding other options such as a maze. Research people, educate yourselves.
Deborah Trenchard (1 год назад)
Dr Gupta, I discovered you ...by chance...two weeks ago and I'm addicted to your videos. I had valvular surgery last October and have two biological heart valves. My heart went into Afib after the surgery. I had a cardioversion but my heart soon returned to Afib. I haven't any symptoms. I am grateful I saw this video because I am due to see my cardiologist in a few weeks' time and now I'll be armed with the right information regarding an ablation should it be offered to me. Meant to be!! Thank you. I did share the video on FB by the way!!
Noboil Frog (1 год назад)
Interesting video thank you doc, I wondered if you had seen Dr John Bergmans video on the subject? https://youtu.be/yjRqpwmRuts
Elise lovella (1 год назад)
i have svt should i think twice on getting ablation
Joseph Fallon (1 год назад)
Great Guy to listen to learned a lot Given me a lot of thought . Thanks DR. Gupta
TIM O'ROURKE (1 год назад)
Very helpful. Thank you for passing on your extensive knowledge to help people
Jay Dee (1 год назад)
Dear Dr. Gupta: I want to whole-heartily thank you for taking the time to make these videos. You have a simplistic way of communicating, and it is refreshing. I find that most cardiologists I have met with have little time to spend with each patient. Hence, efficient explanations of conditions and treatments are lacking. This is frustrating and scary. I am a 44 year old female with two Masters' Degrees, yet sometimes I feel as if my cardiologists are talking down to me. Your videos make the academics of the heart easy to understand, and I thank you for taking the time to explain. You definitely have some controversial positions (AFIB/STROKE), but you present your ideas logically, which makes it worth consideration. I'm really enjoying your videos. Many many thanks. Jennifer P/S I wish you were in the States!!!
Fran Sinclair (1 год назад)
It could kill you then there is no quality of life,, no life at all
Fran Sinclair (1 год назад)
apparently 1 in 100 die from this. Is that true,? THat is like standing out on the freeway and and 1 in 100 person gets knocked down by a car. Would you stand on that road? no
pats pad (1 год назад)
I am not overweight nor do i have sleep apnea and still have a problem.
pats pad (1 год назад)
I am not overweight nor do i have sleep apnea and still have a problem.
Vesna Tomasevic (1 год назад)
Thank you for your video. I was diagnosed with a AV nodal reentrant tachycardia (AVNRT) a few months ago and my cardiologist suggested ablation. I'm not on any kind of medication (I only use the ones for treating hypothyroidism). I'm considering doing the ablation and I'm looking for more information so I stumbled upon your channel which I love! :) I'm quite afraid of the procedure, especially now that I heard it's a pretty "young" technique and long term consequences are still unknown. I would really appreciate if you could give me some advice...
Vesna Tomasevic (1 год назад)
Thank you very much for your quick response. :)
York Cardiology (1 год назад)
For an AVNRT, ablation is often the best treatment. The video i have done is ablation for Afib which is a very young technique..for AVNRT have an ablation and it will cure you if successful.
Allen Sandusky (1 год назад)
Another great video. I am newly diagnosed with AF. Can you have an irregular heartbeat but a normal rate?
Henry N Narsing (6 месяцев назад)
Allen Sandusky I am an Afib since 2012 . To my mind, an irregular beat means the pauses between beats are not the same. On normal means regular beats below 200. Abnormal beats are others
York Cardiology (1 год назад)
yes definitely...have a look at my four types of palpitations video
nicka Williams (1 год назад)
What is your advice on someone who has WPW? My cardiologist recommended Catheter Ablation.
seth (5 месяцев назад)
anyone with WPW WITH symptoms should get an EP Study which they will most likely ablate during it. It's quick, easy, and effective. And depending on your circumstances, you can stop taking drugs after it's complete. Your decision should be based on symptoms but know that symptoms can become worse over time.
Prashant Koirala (6 месяцев назад)
jack hack hey that's what most people with this say that doctors dont care they do and trust me i know i am a med student. I too have PVCs and anxiety. Trust your doctor. If you dont wanna live with your condition and live a carefree and healthy life have it done. With AF you might get stroke or even Vfib in some cases. Please trust your doctor.
jack hack (8 месяцев назад)
I’ve been diagnosed with WPW on February 2014 even though I didn’t have any symptom just my ECG is not like normal person. On November 2017 till February 2018 I spent 4 months of sleepless night, afraid that I might die during my sleep. I’ve severe chest pain and occasional palpitation, the doctors recommended me to undergo ablation, they didn’t even gave me any medicine saying that ablation is the only option. Then at last, I met one Cardiologist who said that ablation is not only the option infact it can also be treated by medicine but had to be taken for almost life time. So, if my life expectancy is 90 years than I have to take medicine for almost 70 years. I took his advice and on medication for 4 months but my condition worsens, my chest pain doesn’t go away, I cannot stand straight or walk or breaths air properly due to chest pain. My chest xray is normal, so I told my cardiologist, he said that since I don’t have palpitations or any other symptoms its ok if I continue medications. As for my chest pain, he gave me some tablet, I am surprised that after one week I can feel that I am healing from inside, my chest pain is gone although my ECG will never be same as normal human. So far I don’t have any symptom. My suggestion is that ablation depends upon the severity of the patient, how frequent is it, is it affecting the normal life, is there frequent blackout. Doing ablation too early like 25 to 45 years of age is risky for me, why? Because its too early to mess normal life of a person or too early to die. What if ablation makes symptom worse as there is a 1% risk of heart failure or palpitation becoming worse after ablation. Most of the doctors are careless in my case and suggested immediate ablation. If it can be treated by medication then why this ablation as long as the symptom doesn’t bother too much?
Othello (8 месяцев назад)
jack hack I also have WPW. I'm currently experimenting with magnesium and CoQ10. Too soon to tell how effective they'll be.
jack hack (8 месяцев назад)
For me, based on online survey, I would prefer not to do it even though I have also been diagnosed with WPW. Lots of people have a mixed reaction for ablation based on their experience, since it has possibility of death. If some procedure even has 1% out of 100% chances of death why should anyone do it, doctors aren't god, if one makes mistakes it cannot be undone. Please someone suggest remedy so that it can be treated naturally. Don't fall for doctors
Cindy M (1 год назад)
Why does removing the AFib not reduce the risk of stroke? I have a mechanical mitral valve, so I am on warfarin for life, but just curious.
York Cardiology (1 год назад)
have a look at my video 'why i dont believe AF causes strokes'
Ashley of Naath (1 год назад)
Is an ablation a good procedure for inappropriate sinus tachycardia? I've been dealing with this for over a year, and while I respond to beta blockers, I don't want to be on them all my life. Also my tachycardia hasn't gotten better over this Year. I'd like to cure the problem and get my life back. I should also mention I don't have a rhythm issue, just rate.
Rellikkk (1 год назад)
Ashley of Naath same here..you found any cure yet?
blue sky (1 год назад)
Nice to get the the pros/cons of any medical procedure/treatment because they always exist glad that this video posted by Gupta does just that- helps a person to get more informed, of course ultimately the decision rests with the patient,After all health care is also a business and you have to wonder how many treatments/procedures are necessary, he makes sound very logical/reasonable arguments as to procedure - ex. invasive procedure and having parts of heart burn isn't natural and if there are other alternatives one can consider, shouldn't just rush to do a procedure because a doctor recommends.
TheSwampStalker (1 год назад)
I was having 2-4 episodes of SVT per week, brought on during martial arts training or any other intense exercise. I am now 6 weeks out and it was the best thing I have ever done. After 20 years of SVT following exercise, and skipping beats throughout the day, I feel like a new person. I was extremely apprehensive going into this. I wont even take a Tylenol unless I am in real pain. I even recovered from a ruptured Achilles using non-surgical methods I was so worried about being put under. But, I faced all my fears and apprehensions and just did it, and am so glad that I did. I highly recommend this procedure if A-fib or SVT is effecting your life. Do your research. Find the best facility and doctor you can find, and do it.
York Cardiology (1 год назад)
i agree... ablation is fantastic for SVT. For Afib, worth considering if quality of life is significantly impaired but not as successful as for SVTs
smiling dolphin (1 год назад)
I'm having an ablation on Fri for new onset afib I've never had any heart issues. I'm only 50 and a female possibility it could be sleep going to r/o with a sleep study. my question is...I just started working in a GI lab the chemicals are strong started noticing I could smell And taste the solution. started doubling masking. is it possible that my afib could be chemically induced? this all started when I started this new job. I'm nervous about the ablation but, I also would like to curb going into a leathal rhythm and not being able to come out of it.
smiling dolphin (1 год назад)
well explained
York Cardiology (1 год назад)
thank you!!
Jess C (1 год назад)
I can't believe your a cardiologist. Your video contains FALSE information.
Ken Townsend (2 месяца назад)
Typical internet troll. Comes into a constructive discussion, lobs in an inflammatory statement and then scurries away, never to be heard from again. Smh.
Lucky 1038 (2 месяца назад)
Maybe you should learn how to spell before making corrosive statements about a respected cardiologist, Where did you do your residency in cardiology?
Holly Nettles (11 месяцев назад)
Everything Dr. Gupta said is identical to what both my cardiologist and electrophysiologist said to me before I decided to have this surgery. What part do you find false? The only difference for me is my doctor thinks that in my case there's about and 80% chance it will be successful (because of my age, length of time I've had AFib, and that I'm not constantly in it).
Anderton Scott (11 месяцев назад)
Every think Dr Gupta said is spot on about every thing he has said I have been told exactly the same thing from ep doctors at top United States hospitals.
York Cardiology (1 год назад)
which bit is FALSE?
Rosemary Lawrence (1 год назад)
I think what sanjay is saying is true Even after supposedly successful ablation , the patient has to stay on Blood thinners for life., I should know I've had two plus two Urgent cardio versions due to inept Electrophyiologist.. who tore my heart lining , and had to have two shocks after as I went into immediate AF I have been told I can have another ablation But Im very interested decided I cannot have a pacemaker as my heart rate is to slow.. so I have 3 Choices What would any one with AF do if they were faced with this decision ?
Patagonia Zox (1 год назад)
thank you very much.
Mary Pedersen (1 год назад)
really appreciated what you had to say
what an awesome video, once more, I have learned a lot more about my condition.
dahls (1 год назад)
thank you for posting this video. i showed it to my father who was considering one given a recent doctor's visit. the doctor wasnt as forthright and thorough as you though.
Ben Jackson (1 год назад)
I think you're on the right track. I have very bad heart palpitation to the point where it is debilitating and chronic. I am not overweight, I used to be athletic, I try to eat healthy, but i have been overloaded by stress the past 16 years and it has literally fried my nerves. Stress is a killer. I may look healthy, but my heart seems to have rhythm issues and not rate issues. Atenolol works to some degree, along with ativan, but it isnt a cure all. I do not drink, smoke, or do drugs and still I have painful PVS's, no dizzyness or increased heart rate, but I have about 50 - 100 palpitations a day, so I may consider this type of surgery. If anyone wants to chat about this feel free to email me. Thanks
Rellikkk (1 год назад)
Ben Jackson exactly the same case for me,how old are you?
Ben Jackson (1 год назад)
THATS SO TRUE! I get most of mine at rest, and when I wake up too! Hit me up in PM if you wanna talk
Ben Jackson (1 год назад)
Thats funny that you say that this happens generally more at rest. Yesterday I went out kayaking and experienced the same thing. I probably rowed several miles, trying to push myself to see what i could do and didn't have many issues while doing the physical work. I had a few PVC's but nothing big. I felt extremely weird last night in my chest though. But you're 100% right, this condition affects your heart more at rest than while working which suggests it could be a curable condition. Ive heard stories of atheletes with strong hearts being affected by this condition, so its not just people with bad hearts. Keep us updated to your decisions and if you wanna chat more contact me through my youtube contacts
Anointed Shamoun (1 год назад)
Ben Jackson I have wpw & am considering a cardiac ablation I was diagnosed @ 14 and I am 30yrs old now. I was nervous about getting this procedure but am trying to work out the kinks to get this done I am on beta blocker for the last few years and it's looking like ablation is going to be the only option to cure this syndrome... I am able to work still and I go hiking and walk the dogs but I get most episodes when I'm @ rest & also when I'm waking up in the morning... I was wearing a holster monitor & my cardiologist picked up 235bpm for 3 min & what's more messed up is I didn't even feel it.... he said it's because I'm young and the scary part is you don't even realize it sometimes because young hearts can handle it more & esp if your in shape. I'm in the process of getting a second opinion just to make sure this is the best thing I can do for my body since I always want to do the least invasive option unless it's truly needed otherwise.... I have done a lot of research and some things are good and some are not that good but overall the success rate is pretty high for this procedure and it comes down to the right doctor which plays a big role esp being board certified in this area.
Katie Bradfield (1 год назад)
I just posted my video of me in the recovery room after an rf ablation if anyone wants to see. if they didn't do it they wouldn't have found the hole in my heart. They also weren't able to get all the areas ablated. I was in surgery for 6 hours. I had episodes every day all day. I have focal atrial tachycardia and asd.
Nicholas Mills (1 год назад)
Katie Bradfield that hole is a pfo:) a small hole in the heart. A smart cardiologist, would of done a tee with a bubble study after there was noted a fib with a good imaging abnormal echo. Usually symptoms starting in the thirties. I hope all is well :)
Katie Bradfield (1 год назад)
It is the radio frequency ablation. I posted some follow up videos. I'm starting to get off meds to see if I'm okay to pass on the next surgery cause they would have to do two surgeries in one and one of the surgeries they really don't want to do cause I might not survive it. so hoping I can live with what they couldn't get. I hope you have a speedy recovery.
Elroy DPenha (1 год назад)
Dr Gupta what if my father has ILD, could this be causing his heart beat to race, His doctor has recommended ablation, What do you suggest
Jeffrey Collier (1 год назад)
Thank you, doctor. You have a wholistic approach to diagnostic explanations and that is wonderful for us patients. I wish I had come across your videos before my ablation procedure for excessive pvc's. I was desperate to return to my work which requires yearly EKG's and was willing to do anything to rectify my situation. In hindsight, I believe that if I had cleaned up my lifestyle some, i.e. lost 20-30 lbs, reduced caffeine intake, cleaned up my diet and exercised more, I may have been successful in treating my own problem.
Jeffrey Collier (1 год назад)
One would assume, logically, that if atrial fibrillation is eliminated through ablation, then the increased risk of stroke would be eliminated, not erased. Everyone has some risk for stroke, don't they? Why would the increased risk of stroke still remain after ablation?
Jeffrey Collier (1 год назад)
jojo4073 Yes and no. The procedure was an immediate success but I required a three month healing period before facing a battery of tests to regain my license. Unfortunately, my heart healed too well and pvc's returned at about 2 months. But, my pvc's have decreased from 40% to 30% to less than 20% which should allow me to regain my license and return to work!
jojo4073 (1 год назад)
Jeffrey Collier did the ablation stop your pvcs?
Joe Wlad (1 год назад)
Thank you for your perspective. I'm just beginning to wrestle with this now. My preliminary diagnosis is Afib, but more tests are needed to get an exact diagnosis (these will take place in the coming weeks). My quality of life is being affected. I'm a life-long runner and at age 56 work out 6 times per week. My heart rate and BP are normal. In fact, I can often do my 3-mile run without any problems but I do feel tired afterwards. Doing weight training is more difficult. It takes longer, I'm tired and dizzy sometimes. I have trouble sleeping on my left side due to the fibrillation. In my case (where the arrhythmia is present nearly 100% of the time), is there medication that will address it? Or does the medication only address the stroke risk?
Eli (2 года назад)
So glad I found this video! It's helped so much sir. I have a couple questions in regards to af I hope you don't mind answering. I was recently diagnosed with af (the type that comes & goes) though I have been feeling quite tiered & lethargic since & am conscious of my heart beats (could be physiological). I exercise daily with weights & cardio, have no allergies, do not take any drugs or anabolic steroids & have no family history of heart disease. So I'm sure you can understand why I'm so confused right now. The cardiologist I've spoken to has thrown the idea of an ablation by me but all the info is a bit overwhelming atm & im not sure on what to do as I cover most parts in terms of general health. However, I have been battling with depression & quite bad anxiety for quite sometime. I haven't attempted to seek help for it & it is taking its toll on me. Question is, would you recommend I consider having the ablation? & when you say your chances of stroke do not decrease after an ablation, do you mean the chances of stroke are the same as anybody else's or remain the same as it did when you had afib? Sorry for babbling on. Liked & subscribed btw!
York Cardiology (1 год назад)
Ok noone here is a challenge... show me one single guideline which says it is okay to stop anticoagulants after an AF ablation if you have a high CHADS2VASC score... one single guideline. Put your money where your mouth is ...one single guideline from a learned society which says it is okay to stop anticoagulants after an AF ablation if you have a high CHADS2VASC score. It is easy to troll someone anonymously...be a man.. show me the evidence, show me your qualifications, show me your experience managing patients with AF... if all you have to back you up is that 'i was ok with an ablation and therefore you will be too' is all you have to back yourself up with then you are the one who comes across as an idiot.
York Cardiology (1 год назад)
Have a look at my video on why i don't think AF causes strokes. that should explain a lot.
Eli (1 год назад)
noone noone thanks a lot sir, had an ultrasound recently & apart from the afib, I've been told my heart is in perfectly good condition. I'll make sure to ask what my CHAD score was. Thanks again for the priceless information. I'll need all the advice & cajones I can get over the coming weeks.
noone (1 год назад)
Eli I'm sorry that I can't help you with that as I'm in the United States. I can, however, highly suggest that you seek out an Electrophysiologist Cardiologist as he specializes in heart rhythm. Make an appointment and get as much information about him; such as years of practice, his specialty (cryoablation or RF ablation), and how many of these procedures he or she has done. Also talk to other people who has had the procedure done and how they've done afterward. Also what blood thinning medication he'll use, and how long before and after the procedure will you be on it. Also, I would highly recommend to have an ultrasound of your heart to see how healthy or if there are damage, and what your CHAD SCORE is, etc. CHAD SCORE will help your cardiologist determine if your susciptible to having blood clots. Mine was zero. That's my suggestion for you. Good luck and God bless.
Eli (1 год назад)
noone thanks for the information sir, really appreciate it. I hate to criticize professionals in health care but I have to agree with what you said. I've been complaining of palpitations for years (since I was in my late teens) (in my early to mid thirties now) & more recently, before they diagnosed me with paroxysmal afib, had bouts of tiredness, lethargy & anxiety. All times they turned me away with the same, "you just need to rest, could be stressed related, stop taking supplements like creatine" crap. I always knew there was a problem, just never knew what obviously. Anyway, just glad I now know & have a chance to deal with it. I could have easily just collapsed one day like you see happening with some young athletes out there. So in that aspect I'm grateful. Do you recommend any heart specialists in London & the U.K. ?
Becoming A Better Me (2 года назад)
I had one last week.  I was nervous at first , but I will say its the best thing I could have ever done.  I am 43 years old and had Afib since 30.  I am great now.  The only thing I have is the soreness around my groin.  But that's going away too.
Mary Osterlund (2 года назад)
I would like to say that yes, it is not natural to have an ablation. Taking the drugs available for this condition is not natural either. They are very very hard on your body. The quality of life with afib. is terribly scarey and limiting. Fainting and not being able to breathe very well, and feeling that doom that is so awful. I think that an ablation is like a miracle to me. I have had three and am going to have another soon. Everytime I have had one it has improved the function of my heart. It is not gone but I am hoping that it will take care of it. I want to live and meds don't work for me.
noone (1 год назад)
Mary Osterlund What type of ablation procedure have you had done? Was it Cryoablation (freezing) or was it RF (burning)? I had the Cryoablation procedure done and Thank God it has stopped my A-Fibs. I was going to ER 2-3 Times a week every week since December 10, 2015 up to the week before my ablation procedure, which was on 4 Aug. 2016. It worked for me!! 1 ;-)
mastio2007 (2 года назад)
stem cell is the future .... they already experimenting on patients they inject certain stem cells in your heart and they will control your heart rhythm is called Biological pacemaker!!! this is very advance technology it also repair fibrosis I believe try to hold on if you can !!!
Elizabeth Bholanath (2 года назад)
how dangerous is it to have major back surgery with wpw..
Racataian Gheorghe (2 года назад)
Hello, I have extra ventricular systole. I had 4000 per day and I feel completely bad - I can not concentrate, work or do anything. During the ECOgraph exam everything was in order physically with the heart. I took a lot of magnesium at the beginning with no effect and then doctor recommended Rythmonorm which works ok, meaning that If i take 1 per day I feel ok the whole day. Looking at the side effects of this drug I am really worried. I saw that you don't recommend ablation but I don't know what else to do: is there something that I could do/test to make this thing go away: I do sports, I don't smoke, occasionally drink, not overweight . Unfortunately in Romania, doctors are not very friendly and I can not have an open discussion Thanks for your time
noone (1 год назад)
Racataian Gheorghe You're absolutely right! Let me issue a public apology to everyone for my outburst. This Forum is for serious illness and whether we agree to disagree with this doctor, he deserves the respect by virtue of his profession. So doctor and everyone, please accept my apology. Thank you for bringing this to my attention. Best of luck to everyone and God Bless.
Racataian Gheorghe (1 год назад)
Hey, this does not help from either of you
noone (1 год назад)
You must have been a Hillary Clinton supporter and crying because the lying, law-breaker and should be prosecuted beyatch lost! Well, well--your true color showed. You make me wonder how you are really with a patient. Best of luck to you!!!
York Cardiology (1 год назад)
Spoken like a man who has just elected Trump as president:-)
York Cardiology (1 год назад)
he is talking about extrasystoles.. you idiot, not Afib!
MrHighgate123 (2 года назад)
I had a very fast heartbeat for years this came to a head last september(15) taken to hospital with a pulse of 215 beats a minute,then again in nove 176 beats a minute,i had a choice medicine for life or an ablation,i was told a had a re-entrent circuit.Cut a long story short i had my ablation in may(16) and was diagnosed with right atrial tachycardia and it was according to the surgeon successful.Operation no big deal,awake the whole time(4 hours) now i feel fine no more fast heartbeat,but anxiety is a real problem probably because its my heart not a simple operation.I believe from experience its medication for life or an ablation,but my heart is actually very healthy so i dont have any other problems,and i also believe that a lot of heart arrythmia problems are brought on because you have another problem with your heart and this brings on the palpitaions etc-but i might be wrong-ablation no big deal i hope its worked but only time will tell.
Gregory T Barrett (6 месяцев назад)
What is your diet like? I have been living with a fib for 11 years and changing my diet has opened a new window of quality to my life with AFIB. IT WORKS ,,, Good Health.
Yowt Hubert (1 год назад)
Contemplating an ablation because about once a month I get fast heart beats necessitating Adenosine cardioversion, it used to go away quickly on it's own since i wa little, not anymore. I hope it was permanently treated for you, please update me. Thanks!
ainanor (2 года назад)
My mother had 3 strokes as a result of A - Fib but the docktors don`t recomend ablation, because its risky. She is taking heart rate medications plus bloodthining med. but her condition is not good. She can barely breath or walk. My mother developed A - fib after heart surgery. How can she treat the A - fib? if the medications are not working can she ask for ablation treatment? I find your videos very informative thank you!
Sergeant (2 года назад)
I have just run your point about post-surgery blood-thinning medicines by my cardio-surgeon and he has said that it DEPENDS on which type of ablation surgery you have. It is not as clear-cut as to say that you always need post-surgery medicine, it is entirely subject to personal circumstances and requirements.
Michael Miller (1 год назад)
I'm scheduled in a few weeks for an EP study and ablation, I was having many Pac everyday and felt each one, and on beta blocker. Now the last week, they have calmed down, I have not been in A-fib in years, my doctor said he can stop the Pac about 85%...so should I do it? I am annoyed by pac...and now am afraid I may damage my heart.
York Cardiology (2 года назад)
thats not the ablation i am talking about. I am talking about AF ablation or pulmonary vein isolation
Sergeant (2 года назад)
+York Cardiology, thanks for your reply. The surgery that I'll be having is: "The codes are K5780 Ablation of accessory pathway or modification of AV node, X3510 local anaesthetic & sedation by operator"
York Cardiology (2 года назад)
this video is on ablation for atrial fibrillation. Your doctor knows you better than me and so you should listen to him
Henrik Pedersen (2 года назад)
I had this done 2 years ago at Skejby University Hospital in Denmark and i cannot recommend this treatment. Here 2 years after the ablation i have huge problems with high pulse and i have visited Skejby many times but they are not able to help me. I am not satisfied with the treatment from Skejby and i have a feeling of not being in professional hands. No one informed me about the risk of high pulse and i have to take medicine with side effects for the rest of my life. Before the ablation i was a very active runner but now my running capacity is reduced. My life was better before the ablation.
80's Nostalgia Guy (8 месяцев назад)
Henrik Pedersen It's time to give up the running and try a different hobby.
noone (1 год назад)
Henrik Pedersen You're doctor sucks. He is not a skilled doctor. Find a better one that has an expertise to do the surgery. Not all cardiologist are equal in skills.
noone (2 года назад)
Are you a cardiac electrophysiologist? I disagree and you're wrong!! A person does not need to be on a permanent blood thinning medication once he/she had a successful ablation. Get your facts right!!!
George Swift (2 месяца назад)
Am told after ablation to be on thinners for 3 months.
Rex Howells (2 месяца назад)
The doctor's right, the company af keeps that's the problem. Hence the Chad score to see if you need to stay on anticoagulants . I am 67 have type 1 diabetes so have no choice.
julie smith (4 месяца назад)
Red Burtley p,p
joe king (5 месяцев назад)
Random Hooman 244t6
TIKI TIKITRADER (5 месяцев назад)
Henry N Narsing ...It took a long time to pinpoint triggers in my life but I realized breads and beer, even non alcohol beer triggers my episodes. Basically wheat, and Store bought cakes, cookies, candies (probably preservatives) and many drinks with preservatives - even fruit juices with preservatives are triggers for me personally. I have a-fib most of my life I'm 55. I take Sotolol and atenolol. I find being careful about food choices helps somewhat reduce triggers for myself. Everyone is different, but maybe simple changes can help even slight improvements. Best to you
Tim 2232 (2 года назад)
Very informative, thanks
Brit4627 (2 года назад)
Rate or rhythm? Sorry Dr Gupta but disagree those of us in persistent AF will get a rapid increase in HR when exercising, it's probably one of the most common effects of AF, BUT this does not mean it's a rate problem, as the rate problem is caused by the rhythm problem. Treat the rhythm and the rate challenges follow. On the rare occasions I go back into NSR my HR does not rise rapidly on exercise. Plus please stop using the words blood thinning, not merely inaccurate as a description, but the phrase scares people who really need to take anti-coagulants. You are obviously anti ablation, but your objections which appear to be that of it not being a "natural" procedure, Not natural? like metal fillings? or like driving a car of flying in an aeroplane?. You have also poorly described the success rates of ablation, not sure if this is deliberate but 40% to 70% what depending on the EP, bad communication. I am sure you know the success rates depend on length of time in AF the degree of scarring in the tissues and many other factors. And as for stroke risk remaining the same once back in NSR, you have misrepresented this very badly. I wish you well, but this is not a helpful video to anyone considering ablation.
You know of some association of the electromagnetic fields of the earth, Electromagnetic fields of houses, As a result of the electrical system of houses or commercial facilities, There is some study on the effect of the magnetic fields that produce the electric generators in the heart of a person. Your information is very good, Thank you very much for your contribution.
York Cardiology (2 года назад)
+Brit4627 There is a difference between treating the AF and treating the person with AF. Similarly there is a difference between AF getting worse and the person with AF getting worse. Whilst it is true that AF begets AF it is not always true to assume that the more AF you have the more symptoms you have. In fact many patients with paroxysmal AF can feel better when they go into persistent AF because for many of them it is the sudden and unpredictable jump from regular rhythm to irregular rhythm that makes them uncomfortable. When they go into persistent AF that becomes their 'normal' and they are not as troubled. So even though your AF burden goes up, it doesn't not necessarily follow that symptoms will get proportionally worse. Secondly once you are in persistent AF then getting worsening symptoms is largely a rate issue rather than a rhythm issue - if you are irregular all the time then you can't get any more irregular..so any symptoms that then develop are largely a rate issue and for most patients rate control is easier than rhythm control. Secondly, lifestyle modification aims to treat the patient with AF rather than the AF itself..lifestyle changes reduce the occurrence of AF in the first place, reduce the number of paroxysms of AF, reduce need for rate control medications, increase the likelihood of successful cardioversion/ablation and improve symptoms. They even improve overall cardiovascular prognosis and reduce risk of strokes -To me that's pretty good. if you have zero symptoms and still get silent AF and then i have difficulty understanding what extra an ablation can offer - sure you may not need to take beta blockers but you will still need anticoagulants (if your CHADS2VASC score is >2) as per current guidelines and your AF may still recur - how can you be 100% sure that it won't? It can be silent and it can still occur several years down the line. So whilst it is nice never to have AF in the first place, the truth is that at this point in time, management is based around reducing the stroke risk through anticoagulants (and even these are not 100% effective and lifestyle changes are still very important) and reducing symptoms. If you do not have symptoms, then i can't see myself recommending an ablation because practically you will still need anticoagulants and as you have no symptoms, it will not make you feel better (other than mentally giving you the satisfaction of knowing that you have done something about it). If on the other hand you have symptoms, then sure it is well worth considering if simple less invasive methods fail to render you symptom free. Also please remember that whilst a 4% risk of complications may not seem large to an individual, it is significant when you treat a population. I see over 100 patients with AF per month. If i sent them all for ablations, 4 of them will have a complication. In a year that will be almost 50 people. I have to face those 50 people when (or if) they come back. Those 50 people will want to know if the ablation was necessary... what do i say? That is why educating the patient is the most important aspect to managing the patient with AF and i have never in my own practice hesitated in referring patients to an electrophysiologist to have a chat about AF ablation so that they fully understand what it involves from a person who performs the procedure. Ultimately the patient has to understand that only they can decide what is right for them. I can only try and answer their questions and facilitate their (hopefully) well informed choices. P.S with regards to your point about the use of the word 'blood thinner' i will happily clarify in my next video.
Brit4627 (2 года назад)
Dear Dr Gupta, thank you for your reply, and I do appreciate the time taken Let me start with Ablation should only be considered is symptoms and quality of life, as a persistent sufferer although luckily almost symptomless, I agree. However, I am also acutely aware that the longer I am in persistent AF the lower my chances of a successful ablation, and there are those who would argue against you saying that early ablation not only has a greater chance of success, but would pre-empt what statistically is a very high risk that the AF will get worse. So whilst I repeat I do not agree with them (certainly in my own case) there is a strong argument for the early use of ablation simply because it's currently the most successful treatment, those who are treated with rate (worst) and rhythm control drugs (better) have a low chance of long term successful treatment, and almost none of a drug free future. I am still struggling with your rate/rhythm comparison, of course all the examples you give I agree with, but none of this has treated the underlying AF has it? I come back to the argument above, those who have AF and to quote you AF begets AF, or in other words you are likely to always get worse at some point, then it still comes down to the overall decision about when do I jump? It is the classic timing decision that is so hard. I agree with everything you say re lifestyle, and of course everyone in AF should re-visit their lifestyle choices and dramatic changes here certainly mollify AF, but treat it? I actually do know people who post ablation have made really dramatic lifestyle changes and remained AF free for many years, and I also have no doubt that these changes suppress the symptoms and delay the furtherance of AF. However it's a matter of emphasis here, Lifestyle changes will ALWAYS be in the patient’s interests, I get that, as are all risk factor mitigations, but they are treatments alongside drug and/or ablation therapy? Adjuncts without doubt, but primary treatments? I could go on, but maybe one day I shall travel to York and buy you dinner and argue this, as we no doubt have many things in common, but some certain disagreements, and here is one. The term "blood thinners" is very commonly used, far too commonly used, but if you really want to know what it does, read the forums that I know you do read and come to the AFA patients days and listen to people who are prescribed warfarin especially and are literally scared witless about them having a "bleed" or taking "rat poison" mainly because and due to the widespread use of the term "blood thinners". You and I both know this is literally an inaccurate description, so I ask a favour read the forums and just search newly diagnosed, or new to warfarin, and then please come over to the enlightenment, and us your considerable influences to stop the use of the incorrect terminology, which does scare some people and literally stops them taking these lifesaving anticoagulants. There's nothing scary about your blood clotting slower than usual. There's a great deal scary about my blood being "thinner" Lastly an apology, the use of the term "badly misrepresent" was both inaccurate and misplaced, I apologise for its use in my previous post. And I also agree we are long overdue a long term study into stroke risk when back in NSR for AF sufferers, and further personally even if I had a successful ablation I would probably continue on an anticoagulant. However we are also overdue a long term study into the prolonged usage of anticoagulants, and there effect on other bodily functions, several studies have thrown doubt on their longer term usages and particularly the effect on osteoporosis and of course the long term side effects of the use of NOACs is still almost an unknown. I wish you well Dr Gupta, I simply ask that as an influential voice in the regrettably increasing world of AF you do consider there are alternative arguments.
York Cardiology (2 года назад)
+Brit4627 Thank you for your comment. Let me start off by saying that a) I have never had AF myself b) I am not an electrophysiologist and don't do ablations... for some these 2 statements alone are enough to discredit all that i have to say. However i have been a practising cardiologist since 1998 and have looked after thousands of patients with AF - some of whom i have referred for ablation with good results and others with not as good results. 1) The ONLY reason to consider an ablation for AF is symptoms and how they impinge on your quality of life and as i say in the video, this is a very subjective thing - only YOU know how it affects YOUR quality of life. I have met some people who have NO symptoms despite being in persistent AF or having frequent paroxysms and i have met others who feel horrible even if they have infrequent paroxysms lasting a few minutes. To those people who have no symptoms, what exactly is an ablation going to achieve? 2) If you do have symptoms, it is helpful to know exactly why you have them. There are several people i know who feel breathless when they start walking. Put them on a treadmill and you will see there heart rate shoot up from 70 to 180 in a minute. Control the heart rate with a beta blocker and such patients feel much better (it may not be applicable to you but there are several people out there who it is applicable to). If the beta blocker doesn't cause the patient any side effects and renders them symptom free, what exactly will the ablation achieve? Of course in some people, it is simply being irregular rather than irregular and fast which causes the symptoms. If this were the case then such people would feel better by going back to sinus rhythm..but they form a subgroup rather than the entire population with AF. 3) 1 in 5 people i see have sleep apnoea. I in 3 have hypertension (often poorly controlled). I in 3 are obese. All 3 conditions drive AF. Send them for an ablation without educating them on their lifestyle, treating their hypertension and treating their sleep apnoea and the AF will recur. I challenge you to find a single cardiologist in the world who would say otherwise. 4) I am not anti-ablation but i do think that it should not supercede education, lifestyle counselling and risk factor modification and before considering it a patient should know exactly what they hope to get out of it. If a person wants to feel better because it is affecting their quality of life then it remains a reasonable option but if a person wants to have it done because it is a definitive 'cure' then there is no guarantee. 5) RF ablation results in scarring of the heart and we have no long term data on what this may mean. Af ablation was only first developed in 1999 so we have less than 16 years of experience of what the long term sequelae of iatrogenic scarring entail. In addition, the procedure carries with it some risk. Have a look at this website http://oliversegal.com/heart-conditions/af-ablation-the-laser-balloon/ Would you be happy to fly in aeroplane if there was a 4% chance of something going wrong? Even if you would, would you not want to know about the risks beforehand? i think there are several people who may decide that there symptoms are not intrusive enough to take on that chance. I am not here to put them off..i am merely stating facts. 6) With regards to success rates, there are several variables - it is impossible to quote a specific figure. It depends on the patient, the doctor, whether the AF is paroxysmal or persistent, whether it is the first attempt or the 10th and the luck on the day. How on earth can anyone quote a specific figures when you have so many different variables. Even if you have a great electrophysiologist who can boast a high success rate, the truth is that every patient is different and the only time you truly know is after the doctor has done the procedure as to how confident he feels that he was able to ablate successfully. Then there is also the test of time. Only time can tell whether it helps your symptoms or not. There is also an undoubted small but real placebo effect. 7) With regards to using the term 'blood thinners'..this is a commonly used lay term for anticoagulants Whilst it is not strictly true that they thin the blood this is the term used by the Mayo clinic - http://www.mayoclinic.org/blood-thinners/expert-answers/faq-20058261 the cleveland clinic https://health.clevelandclinic.org/2015/03/should-you-take-aspirin-if-you-are-on-blood-thinners-video/ and NHS choices http://www.nhs.uk/news/2009/08August/Pages/PradaxaTrialledAgainstWarfarin.aspx I have never had a single patient come to me and say that they this phrase has scared them any more than the term 'anticoagulant'. Please show me the data to suggest otherwise and i will happily redo the video. 8) With regards to the stroke risk after AF ablation, there are no large scale prospective double blind placebo controlled randomised trials which have definitively shown shown that patients with a CHADS2VASC score of > 2 can happily and safely stop their anticoagulant after their AF has been treated. NICE stress in their most up to date guidance that anticoagulants should not be stopped even after restoration to sinus rhythm. This is not misrepresentation by any means. Here are some other interesting articles for your education: http://www.medscape.com/viewarticle/845106 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321065/ Please show me one large scale prospective randomised placebo controlled study which has definitively proven that the stroke risk after AF ablation is lowered to the extent that patients with a high CHADS2VASC score of >2 can safely stop anticoagulants for life - I challenge you to find and name one cardiologist who can give you a hundred percent guarantee that he will cure your AF with an ablation and therefore completely eliminate your future stroke risk if your CHADS2VASC score is > 2 and who would therefore feel completely comfortable with you stopping all anticoagulants for life. - if not, please do not suggest that i am 'badly' misrepresenting anything Ultimately it is your body, your AF, your quality of life and your choice. I merely aim to give people the information i would give my own mother if she asked me the question.

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