Catheter Ablation

[homesick rae]

I have just had a letter from Admissions saying I am on the waiting list for "a procedure." The above was discussed with the doc but he said that was long term. I am due to go back and see him in December so did not expect this! The chat in December is to see if the increased beta blockers are working, so I am a tad confused as there has been no indication that this was becoming slightly more urgent!?

As for a Catheter Ablation, I have read up on it but really do not like the thought of the surgeon poking around with wires up my vein. What are the options, if any? Can medication alone cure this arrythmia permanently?

Cheers

HR

[sky9]

I suffered from Tachycardia and the CAA wanted me to have an ablation. I had been advised that when the operation is carried out a full surgical team is in the adjoining theatre in case you have complications.
One of the side effects of an ablation is that there is a possibility of needing a pacemaker afterwards.

I was about 45 at the time and decided that I would decline the offer. The consultant put me on Sotalol and after some checking the CAA allowed me to continue flying with an "asorwith" licence.
Hope this helps.

[homesick rae]

Sky9,

As it happens I am 45.

I am on Atenlol 50mg daily and feel better for it.

Hmmm, I think I might go with your option.

BTW, I am ex Cabin Crew...years ago.... but now in senior management in the aerospace industry.

I've put on weight but feel F""""""""G great!

Cheers for your reply,

HR

[ekardj]

Without a bit more information it is difficult to give you definite advice. I presume you have had episodes of fast heart rate or irregular heart rate which might be due to an abnormality of the conducting tissue in your heart. If this can be controlled by medication then you may not need to have an op. I guess that catheter ablation is where the cardiologist puts a probe onto the abberant conducting tissue and essentially stops it functioning allowing the normal part of the conducting tissue to work without interruption. You would be in good company if this happened as Tony Blair had something similar done a couple of years ago I believe.
If you are not sure talk to your GP or the cardiologist again. Just say you did not fully understand first time he explained it.

[WKA]

I was failed on a class 2 medical two and a half years ago,because of atrial flutter.After various unsuccessful treatments,I had a catheter ablation at Papworth by a leading cardioligist,which was completely successful and still is over two years later.Now the bad points,three months later I suffered from a mild stroke (TIA) which was probably caused by me being taken off Warfarin (anti-coagulent) six weeks after the ablation. I believe in America warfarin treatment is taken for a six month period post ablation. Because of this problem and the insistance by the CIA for me to have an electrophysiological study, which is basically a similar procedure as the ablation treatment, and also very costly!!
(if it ain't broke dont fix it) my exercise ECG, 24 hour holter recordings and echocardiogram were all acceptable for un-restricted Class 2 as confirmed by the CAA. Because of the TIA I was advised to go on to permanent Warfarin treatment, which precluded my re-certification.
I feel extremely fit and well and would recommend ablation treatment, subject to the previous comments, I am flying again on an NPPL but because of the restrictions I am unable to fly outside british airspace and as a result I am selling my aeroplane and recluctantly finishing flying. I feel that had things gone differently I would be flying under normal CAA certification.

[Albert Driver]

This is how I understand it.

There are two alternative ways of dealing with this problem: "Rhythm control" and "Rate control".

Rhythm control means getting the heart back into a normal (sinus) rhythm by some (usually physical) means. Electric shock treatment may work but the problem often returns and this treatment usually doesn't work if you've had the problem for some time. Ablation is a permanent fix if it works, but sometimes the offending area of heart tissue cannot be found, or if it is found it may be in an area which is too risky to treat. Coupled with this the treatment itself is invasive and therefore carries some risk. You need to know who is going to do it, what his experience level is and what are his success (and failure and mortality) rates.

Rate control means accepting a permanent irregular rhythm but controlling the heart output by chemical means. If the heart beats too fast the ventricles don't fill properly and the output is too low. Beta blockers slow the rate. Some also positively act on the heart and may restore sinus rhythm. Either way they are usually the first choice of treatment. However it is worth remembering there is also a risk to this. If the rate is controlled but not the rhythm, the passage of blood through some areas of the heart is slowed and there is a small but significant risk of clotting and subsequent stroke. Therefore some additional medication is needed to reduce this risk. It may be warfarin etc or simply aspirin.

So here is the dilemma. Accept a small surgical risk and have the ablation done in the hope of a permanent fix - or take the drugs and accept a small but slowly increasing long-term risk of stroke?

It all depends on your age, your other risk factors, medical advice, your attitude to risk, your personal circumstances at the time, whether you have access to a really first class surgical team and much more. There's no doubt the success rate for catheter ablation is improving. At what point does the one risk outweigh the other?

Let us know how you get on.

[slim_slag]

Can medication alone cure this arrythmia permanently?Don't want to guess, you never said what arrythmia you have.

[homesick rae]

No idea! Been going on for 9 years now and this is the first time I have got to this stage of investigation. Cardiologist just said that it is not normal, can be fixed and for the meantime lets increase the betas and see how you go and come back and see me in December. Long term we might do a Catheter Ablation. All of a sudden I get a note to tell me I am on the wait list.

Thanks for all your replies. I think the medicine option is the way I am going to go. I have 2 young kids to think about! I also heard that this can be rectified by laser??

Cheers

HR

[slim_slag]

Probably Atrial Fibrillation/Flutter. Sound familiar?

If you don't know what it is then you shouldn't have the procedure. The reason I say that is because only you can make the decision and to do that you need to be informed.

Given the little that you have said, and if I guessed correctly, I'd probably stick on the medicine too - but you need to discuss this with your cardiologist. I'd ask your GP what is wrong and then do some research so you know the questions to ask and understand the answers he will give you. It's not that difficult to understand, but you need the diagnosis.

The medicine will not cure you. If its AF, then at the current level of experience with the procedure an ablation cannot be said to be a cure either, but it could turn out to be. However knowledge is being actively gathered and the decision might be a lot easier in a few years. In a few years it might be the treatment of choice. But discuss this with the cardiologist.

[Seat1APlease]

If it is AF then there is another option, electro cardioversion, where a shock is applied through electrodes attached to the chest rather like an ecg. to restore the normal rhythm. It is done when sedated so you feel nothing.

It is usually successsful at restoring normal rhythm, but unfortunately if the underlying cause is still there, then it may reoccurr in a couple of years time.


I would talk to your cardiologist again before having anything done.

[homesick rae]

All I was told is that something triggered this. It began the day after I found out my mum was terminally ill! I couldn't feel better really, overweight and don't exercise like I used to but all this started when I was 2 stone lighter and extremely active. I have heard that there is laser treatment to break the circuit and redirect it? The idea of non invasive treatment appeals to me.

Cheers

HR

[effortless]

Laser is still as invasive. It is ablation using fibre-optics.

[Jarvy]

I had ablation last august. I've a CPL(H) and have been grounded for over 2 years. The ablation was done at St. Thomas' and they start by trying to cause the VT I was suffering with. Then they try to burn the pathways within the heart. Up untill the actual burning there was no pain or discomfort but once burning took place it felt like a huge weight had been put on my chest.
No after effects, went home next day.
Jarvy

[homesick rae]

Jarvy,

Thanks for your reply. Glad to hear things worked out okay.

Just actually had in writing that my Echocardiogram was normal and then the letter thanks the other cardiologist for putting me on "your EP list." What is EP?

Many thanks,

HR

[Seat1APlease]

I think he may mean this:-
http://www.hrspatients.org/patients/heart_tests/electrophysiology_study.asp

[homesick rae]

Ah ok, so the same Ablation then...thanks for the link...very interesting although I am not sure which category I fall under!?

Half of me feels happy that the Echo is fine but the other half is worried that they might find something else during the EP...

The beta blockers have made a hell of a difference to me regarding the irregular beats by the way...more infrequent to the point I hardly notice them at all and cannot really say when I noticed them last!

Any cardiologists out there?

Cheers for the excellent replies thus far. Much appreciated!!

HR

[aviationascent]

i too have been through a barrage of tests to try and ascertain what is causing an abnormal looking ecg. after talking with the specialist in april, it seems that it is likely that it is nothing, just an individuality! however, as i am ready to begin my ab initio CPL, (after having saved for years!!!), the only way he will be able to tell for sure is to try and stimulate an arythmia. he is going to get me ready for the ablation and then see if i have the/a condition and that way if i do he can fix it then and there.

i am keen as because this is the only thing holding me back from me starting my training. he says that after this he will be able to say definitively if i have a condition.

not sure if this sounds right and i haven't had a second opinion, but even if i end up with a pace maker, to me it is worth the risk if i means i can fly! (obviously i can't with a pace maker) any doc's or electrophysiocardiologists out there want to throw in there 2 cents???

Cheers
(waiting for the...) aviationascent

[jj_163]

Hi,

I've been following this thread for a wee while now and have also had a catheter ablation (a few actually, twice for Atrial Flutter and twice for Pulmonary vein ablation (for Atrial Fibrillation) - as well as 3 DC Cardioversions prior to that). I had the last ablation in January 2006 and that fixed it and the heart now beats the way nature intended. :) In fact in about 3 weeks my medication ends too and that's it!

I had originally applied for a class 2 medical in 2000 (thought I would do a PPL first to see if I liked it enough to take it further) and was knocked back - well, we will only grant you a certificate with a safety pilot limitation job, i.e. you can't go solo making obtaining your PPL impossible - due to the aforementioned conditions (Atrial Flutter and Atrial Fibrillation - yes I had both, thus the two types of ablation).

Anyway, after ablation you need to see a cardiologist 'approved' by the CAA (get your chequebook handy) - there's a list on their website, who will do various tests (Resting ECG, Stress Test, 24hr ECG, Echocardiogram) and you may need to lay your hands on copies of some of your other cardiac tests etc. and he/she will write to the CAA with their findings.

Anyway, long story short, in Feb 2007 I was issued with an unrestricted class 2 medical certificate, although I had been starting to learn to fly beforehand on an NPPL medical ;). I'm now just a few hours and the skills test (and RT Practical) away from my PPL. So keep the faith!

You should also take heart (sic) that in 2001 I had also managed to have a complete left sided pneumothorax (twice) - this has been fixed though by some medical procedure that I can't spell. :)

I have a further followup with the CAA cardiologist in February 2008, but at present they have not said for definite that I will not be able to attain Class 1 certification in the future should I decide to go down that route. All cases considered I guess.

As a poster above stated the ablation is relatively painless (until they go to do the actual ablation, then you're thankful for the rather nice sedation nurse standing slightly behind you to your right!). It is also completely worth going for it as if/when successfull what a difference it makes to the way you feel.

For your information, I had my ablation done by Dr S Furniss at the Freeman in Newcastle and the guy is an absolute gem.

Just thought I'd let you know - don't give up, it may take a few goes to nail the problem down, but they can fix it. Believe!

Cheers,

jj

[aviationascent]

well i didn't die, i haven't had a stroke, YET!, and the results of the procedure was enough to excite the doctor. what an experience though! some strange sensations.

the doc had difficulty in stimulating an arrythmia. prior to the op i had not suffered any symptoms so to a large extent the op was to determine if i even had a condition or whether my ECG showed merely a 'pseudo-wave'.

the first thing he said when he entered the theater was, "so, we're going to see if we can't get you flying today, hey!?". he is a champ! it was reassuring to know that he knew where i was at, and just what it meant to me.

so prior to successfully producing tachycardia, he told me that he knew where the extra conducting pathway was and that it was a very poor conductor. In fact, it was only conducting one way. It was at this point that he asked if i wanted him to ablate it anyway considering that i did not suffer from symptoms. This carried an extra element of risk as in order to get to the pathway, he would have to go through the inner wall of the heart to get from the right to left ventricle. This made me quite anxious as I didn't know whether to go ahead or not. I had no idea if CASA would look kindly upon me considering my lack of symptoms and an apparent inability to have tachycardia. Before getting my decision he tried again and this time my heart felt like it was going to explode!!! Tachycardia was present. I now didn't have to make a decision, it had been made for me.

Anyway, the rest went off without a hitch. Because it was a very poorly conducting pathway there was only a few short seconds of actual ablation. The doc became very excited once he rechecked the ecg waves. He said that it had been fixed and that they were going to run some tests to make certain. :ok::D

Afterward, once he had checked the ecg against the previous one he concluded that it had gone very well. He actually seemed quite excited.

Now i just have to see what CASA says. i suspect that they will make me wait 24 months with occasional checks in between before granting me a license to learn to fly. My understanding is that I would have to be on a restricted license and wouldn't be able to fly solo. Slight problem there. So will see what happens anyway. I guess it will just give me time to save even more!

[Jarvy]

Follow up to my earlier post. On monday I was issued with a Class 1 with an OML restriction,this acts as an unrestricted class 2. Not much use for a CPL(H) flying small single engined helicopters but its a start.
Jarvy

[aviationascent]

Hey Jarvy,

Do you think it may then be possible for me to learn to fly on a Class 1 OML license??? From what you were saying i understood that to mean that with a Class OML you can't fly commercially, but perhaps i would be able to fly solo in order to learn to fly up to a point. Maybe do my PPL for now.

Cheers in advance.

[Jarvy]

PPL would be fine under JAR rules and you could do a commercial course but could only be paid to fly if in a multi crew helicopter (2 pilot).
Jarvy