If AF syptoms are only moderate is an... - Atrial Fibrillati...
If AF syptoms are only moderate is an ablation still best, or stay on drugs & hope the AF dosent worsen in the future?
Hi Blooto, There is evidence to suggest that early ablation is more effective as it stops the heart from developing extra pathways. Once AF has become persistent or permanent the success of ablation is reduced markedly. It is a personal choice I feel as whilst I was always able to accept the risks, ablation is a serious procedure and not entirely risk free although I still feel that a lot of emphasis is given merely to protect doctors in these times of aggressive litigation.
BobD
Hi
I agree with Bob, but when it comes down to it is up to you and your electrophysiologist
Regards
Blooto, Welcome to the forum...
There are quite a few factors you will need to look at for the answer.
The first would be your age. For a person 30 to 50 or younger, the idea that AF can be controlled for a long period using only meds is not very realistic. Due to the progressive nature of AF higher dosages and stronger meds will normally follow.
That would also hold true for "hoping that it won't worsen. AF normally starts pretty mild and long times between attack and becomes much more severe and frequent over time. I was diagnosed with AF 13 years ago (and probably had it a few years before but thought it was just a panic attack). I stared with 1 or 2 attacks a year lasting 1 or 2 hours and after 13 years I was having 2 to 3 attacks a week and lasting 6 to 10 hours each. AF is sort of like a "Catch 21", The more it happens, the more pathways are developed and the more it will happen.
I agree with Bob, Usually the earlier you catch AF and have a procedure to stop it... The better the chances it will work. Although after 13 years I just had an ablation 4 months ago and am now 15 weeks AF Free.
What meds are you on now? How are they working. Are you taking an anticoagulant? How long have you had AF?
Ok, enough questions.... In the end, as stated above, It's a choice that you and your Dr will have to discuss and decide what works best for you.
Again, Welcome to the forum.
Tim
My view and the view of my EP is that the decision should be symptom driven. When I decided to see a EP after being referred by my cardio he thought I should hold back and keep on meds.
If you cant cope or are having frequent attacks or meds not working you have no choice but to go for an ablation. Albeit it has risks..
My EP did tell me that ablation does not reduce the risk of stroke. Anticoagulants are required post ablation.
Hi Blooto,
As others have said, "AF begets AF", in that AF tends to get worse with time as gradual changes to the structure of the heart take place. I was offered an ablation as first line treatment when I was finally properly diagnosed, and I think an ablation sooner rather than later is the best course. OK I wasn't sure at first, but "things happen" that push you over the threshold into making the decision.
On stroke risk, yes, I have heard the view that Warriors suggests that its not reduced after ablation. But I have also heard the contrary view, that once you are back into permanent normal rhythm, then you have a normal stroke risk profile. I think it has to do with how much scar tissue you have after ablation, which affects the smooth flow of blood through the heart. A question for your EP I think.
Welcome to the forum - use it! - we're always here so don't feel isolated
Best wishes, Chris H
Hi Blooto,
I decided to hold off an ablation as long as I could. So I stayed on medicines for about 10 years before my ablation. By then I was up to about 70% of the time in AF. I didn't want to go 100% as it becomes a lot more difficult to have a successful ablation once you are. Prof Schilling was quoting around an 80% success rate as long as you're still paroxysmal regardless of how frequent, compared with 60% for persistent.
I was glad I had held off as ablation techniques had improved so much in those 10 years, and my ablation was successful.
I think we're on the cusp of another leap in ablation success with new mapping techniques, so if it were me, I would hold off another year or two and do a lot of research in the meantime.
Mark
Hi MarkS
Well im in AF 100% of the time now so I left it too late. Hopefully better techniques will be found to give better success rates for people like me in permanent AF. Im hoping they find a technique that gives a definite cure 1st time round.
My major worry is stroke risk, even though im on Warfarin and it gets me down.
Blooto
Sorry, Blooto, I hadn't realised you were in AF 100% of the time. In that case it might be better to have an ablation sooner rather than later. However the FIRM and PRECISE trials mentioned in the question "New Ablation Results from the USA" on this site has some good news. The new mapping had particular success with persistent AF-ers.
Officially a successful ablation does not affect your stroke risk, however early evidence does indicate that it considerably reduces your stroke risk.
The best thing you can do to reduce your stroke risk is to keep your INR in range all the time - get a Coaguchek monitor and test weekly. If you keep it there your stroke risk is pretty much the same as people without AF.
Mark
Where is the forefront of research into ablation techniques, is there a specific organisation devoted to this? How does one monitor the progress being made with mapping, which seems to be the key to a successful ablation? Is there a point one reaches where further ablations simply cannot be done? And finally ,officially exercise is encouraged, but is there any evidence, unofficially, that for those who have paroxysmal AF this can trigger an episode? So many questions for you knowledgeable folks on this forum!
The key to reducing stroke risk seems to be the use of an anticoagulant, as I assume MarkS does, I use a Coaguchek monitor and test weekly.
Oh, and one more quick question - i find it fascinating that there are those in permanent AF who are symptom free, and yet others who are absolutely knocked sideways, why is this?
Hi Anna,
I'll try to answer some of your questions.
I don't think there is a specific organisation that monitors mapping progress. I monitor NCBI doing a weekly automatic search for "atrial fibrillation". stopafib.org is also a good resource.
Apparently around 3 ablations is the current limit. However this might change with new mapping which may be able to pinpoint the exact location of the errant signals.
I think exercise is really important. It increases your exercise capacity. AF reduces your blood flow by around 15-20%. So if you're fit you can easily continue to function when in AF.
Yes I'm on warfarin and doing well on it with my Coaguchek monitor.
Mark
