ablation

[Musetta]

Hello All,

When and why is the decision made by AFibbers to have an ablation?

Cheers.

[PeterWh]

That depends on the individual person and the individual EP. In my case my EP's assessment was that my only realistic option was an ablation (two months after seeing him for the first time and after I had a cardioversion but want back into persistent AF 24 hours later).

[BobD Volunteer]

When you decide that you no longer want AF and all the faffing about with drugs. OK it may not work first time but something one has to try if serious about improving QOL. OK it sounds scary and there are risks although aren't there in everything. As somebody once said to me "If you are being chased by a lion towards a river full of crocodiles there comes a point when the crocs look the best bet."

[Tamarita in reply to BobD]

How right you are BobD. In my case the decision was as simple as that!

[SRMGrandma Volunteer]

When you are symptomatic and it is affecting your quality of life.

[Hidden]

First you need to be up to speed with AF, all the options and issues. After that it's simple as you will reach a point where 'I need that ablation, let's get on with it'.

Before then I favour postponement.

[AnticoagulateNow]

When you're ready to throw away the t-shirt that says 'I love AF'

[Hidden]

I had 24/7 AF but it was being controlled well by drugs. But the side-effects were unacceptable and getting worse after 2-3 years. So I had the ablation to get off drugs, and it worked and kept me clear for 8 years.

In hindsight, I'd have had the ablation sooner as it was on offer.

Koll

[Musetta in reply to Hidden]

thanks Koll - presently, my AF is pretty infrequent, last one a year ago but

the moment the situation becomes unacceptable, I'll definitely look

into ablation

Cheers,

Musetta

[CDreamer]

For me it was when I had 1-2 episodes a week. I had occasional AF episodes for about 7-8 years but felt I could live with an occasional episode so it was only when they became frequent and quite disabling - I had to give up the job I was doing at the time and I stopped doing a lot of activities. If I had had access to an EP earlier in my journey I think I would have gone for ablation much, much sooner.

Each episode lasted longer and I was taking the highest daily dose of Flecainide. In 2013 you had to fail 2 meds before being offered an ablation and even though my GP thought I was an ideal candidate the cardiologist was against it and there were no facilities to have an ablation without going out of area. I eventually went privately, traveling to London, had 2 ablations which worked and my only regret is not pushing a lot harder, a lot sooner for ablation.

[Musetta in reply to CDreamer]

Hi CDreamer,

Like you over the last three years or so my AF has been infrequent - last episode about a year ago - once this changes and QOL is affected I shall

look into ablation.

Cheers,

Musetta

[jennydog]

When I decided that I couldn't carry on like that any longer. I had become unreliable, had lost confidence and felt atrocious much of the time.

[zara1977]

It never occurred to me not to follow the advice of my EP having found him at last after two years of a general cardiologist. I've had three. Much better than if I hadn't though they have not solved all the problems, the drugs seem to do that.

[Musetta in reply to zara1977]

thanks zara

[Buffafly]

I was given a choice between a pacemaker and ablation because the meds I was taking were causing pauses. My dose was lowered but the opinion of cardiologist and EP was that in time that dose would not be effective, but by then it might be too late.

[Musetta in reply to Buffafly]

thanks for reply Buffafly

[AlanAF]

Excellent question - and I am really interested in the replies. In my case, I have gone for an ablation at an early stage.

My personal reasons are (not in any particular order):

1. I am relatively young (53), so don't want to be on powerful drugs for (hopefully) many years;

2. The drugs have potentially nasty side effects, equalling the risks involved in the ablation;

3. The drugs seem to involve a lot of trial and error on an ongoing basis;

4. Ablation procedures have improved considerably in recent years. I asked my EP if it is worth having drugs for a while to see if they improve further, but he felt they have currently reached a plateau, so not worth waiting;

5. Due to my age and otherwise reasonable health, plus caught the AFib fairly early, my chances of 1st time success with ablation should be better than average, and my corresponding risks a bit lower (touch wood). Again, better to have it now rather than wait;

6. As AFib is a progressive condition, there is an argument to say hit it hard early, hoping to keep it at a lowish level when it inevitably rears it's ugly head again;

7. I have had 2 eye operations recently, which, though I had problems afterwards, have made me a bit more willing to have an operation for the longer term good;

8. (An important one , this) The recommendation of my EP who said, if he was in my shoes, that is what he would do; and

9. The encouragement of people on this forum has also played a part.

Shame I can't make it a nice round 10 reasons. Anyhow, hope they make sense.

Equally, I can see an argument for taking it more slowly and trying drugs first. There are people here who have had many good, AF and side-effect free years from them. And I know that there are risks to the ablation and it won't last for ever.

However, it's just my impression that many on drugs to have an ablation eventually, so bottom line is I'd rather get that done early when chances of success are greatest.

I hope I am right!!!!!!

Best wishes

Alan

[PeterWh in reply to AlanAF]

Well I'll add no 10 for you. The chances of success first time are much higher if someone has paroxsymal AF as opposed to someone who is in persistent AF. Therefore do it before you get to the persistent stage.

With AF it seems to me (as a layman with no medical training) that the drugs mask the consequences and effects of the AF by controlling the heart but for those whose AF is originating in the veins new pathways and rogue cells will continue to be generated. Ie the drugs don't cure as other drugs do. However I may be way off the mark with this theory!!!! I have also utilised knowledge from my original career as an electrical engineer.

[PeterWh in reply to PeterWh]

PS. I think you are definitely right to go for an ablation sooner rather than later!!!!

[AlanAF in reply to PeterWh]

Thanks Peter. You raise a really interesting point. It is addressed in the current Autumn AF Association Newsletter (Question 5), where Dr Gupta from the Liverpool Heart & Chest Hospital says,

'If the underlying risk factors are not controlled, for example through inadequate control of blood pressure or body weight, the firing of these triggers continues to progress till such time that they overwhelm the drug’s effects.'

This implies that, if the underlying risk factors ARE controlled, you should be able to stop or slow progression, which would be good news.

Again, I can only speak for myself, but I thought I had my blood pressure under control (my risk factor, linked to anxiety/stress). Either I was wrong, or I was just going to get AFib whatever. Either way, I didn't feel I could guarentee that, if I took the drugs option, I wouldn't end up with persistent AFib after a while, reducing my chances of a successful ablation.

With the ablation option, I suspect it will also still progress, which is why ablations only last 5-10 years (anyone else have any firmer info ion this?), but at least it seems to last a bit longer than most people on drugs. Unfortunately, there are no certainties.

[teach2learn in reply to AlanAF]

I agree with everyhing you said, and from the point of view of having progressed so rapidly through all the stages of AF as well as failed drugs and cardioversion. Now 15 months AF free! ( minus one day which resolved after one flecainide tablet). Never a moment's regret for ablation...but heaps of praise and gratitude. I have my life back!

[Musetta in reply to AlanAF]

Thanks Alan for the very comprehensive reply! I shall take that all an board and have chat to my cardioman when I see him next. I particularly liked

your point no.8 Thankfully, my AF is still infrequent - last episode a year ago

and the meds so far haven't caused any side effects that I've noticed.

Cheers,

Musetta

[cbsrbpm]

I made this decision when I went from paroxysmal AF 3-4 episodes a year, on flecainide to persistent AF and very symptomatic, breathlessness etc. So far the best decision I made but it's not yet 3 months so I have everything crossed. Only you can make this decision based on how you are coping and your QOL. Best wishes

B🐝

[Musetta in reply to cbsrbpm]

Thanks for reply cbs - once my PAF becomes persistent AF, I will definitely review my options. Cheers

[Rellim296]

My first appointment with a cardiologist happened to be with a locum who was an EP and he said my problems (then diagnosed as paroxysmal SVT) might be solved with an ablation. I signed up with enthusiasm right away.

[Musetta in reply to Rellim296]

Thanks for reply Rellim,

Cheers.

[10gingercats]

I sometimes wonder if I really do have permanent Af....for which I take Apixaban.Lost count of the years I have had iAf but certainly 7-10 and not much has changed in that time apart from having had a hole in the heart fixed. In fact I feel better and better as time marches on. Why ? I am very well and full of energy at 77.....just good luck? and good luck can change? I follow all of the e mails , and esp. new developments and note names of good cardiologists and electropysiologists...just in case I may need them in the future.....Many thanks Alanaf for so many excellent points. I often pass on tips seen here to my brother for his son who at less than 50 has very serious Af problems.