Ablation a

[Kbuck1234]

Is an ablation now recommended as the first line of defence for AF? I have PAF but don't know whether to push for an ablation and just get this fixed rather than meds and constant worry?

[BobD Volunteer]

Many EPs believe it is but do understand that ablation is not bullet proof and that you may need more than one procedure. For some unfortunate people it never does work but for many QOL is greatly improved even if multiple procedure are required. I needed three but AF free getting on for seven years now and worth every second.

[PeterWh]

Yes it can be but may depend on your EP.

Make sure you are seeing or are referred to an EP who does ablations rather than a general cardiologist.

[Finvola]

To answer your first question - I'm not sure it would be the first line of defence but many EP's will advise early intervention whereas others will hold back awaiting the results of drug therapy and taking into account factors such as age, frequency and severity of symptoms.

You mention worry in your second question - if the cause of worry is the possible return of symptoms, ablation may not remove that concern completely - but then it might.

There was some excellent advice from another poster recently - if you decide on ablation, get to the best EP you can find and choose someone with a good track record in performing AF ablations.

[PeterWh in reply to Finvola]

In my case as soon as I had a cardioversion and reverted to persistent AF 24 hours later I was offered an ablation. I had been put onto Apixaban for cardioversion which only took place after I had been on the Apixaban for about 4 weeks. As such I did not have a failed drug regime although I did have some flecainide in the few weeks leading up to the cardioversion to see if it made any difference to holding NSR afterwards but as soon as I saw consultant after going back into AF he took me straight off the flecainide.

[Hidden]

I think the first important hurdle is to understand that there is unlikely to be a 'silver bullet' - this is only for the very lucky few. It will need some acceptance that there is potential good and bad on most choices.

Then it's a question of what you can do on all fronts on your own and with the medics. If you can get stabilised and QOL is pretty good then I think drugs may be best for a while (I'm currently looking at two years) as ablation procedures are improving all the time.

Sorry it's not an answer to your query but I'm not sure there is one.

[dmac4646 in reply to Hidden]

Hi , this is the approach my EP has adopted -stabilise with drugs ( Flec 150mg pd) and wait to see if procedures improve ( which they have) - I have about 3 episodes a year usually caused by cold or chest infection - have been on this regime since 2010 -if the Flec stops working they will try an ablation.

[Hidden in reply to dmac4646]

Hi dmac, may I ask do you take 75mg twice a day or uneven doses e.g. 50mg and 100mg?

[dmac4646 in reply to Hidden]

even 50mg at 4pm 50 at 8 and 50 before bed .... my af is nearly always at night so this protects me pretty well.

[Hidden in reply to dmac4646]

Thanks, that's interesting, hadn't considered that option, will discuss with my cardiologist next time.

[dmac4646 in reply to Hidden]

Mine says takes about 3 hours to fully enter system , reaches max at about 6 and lasts up 20 hours in the system so by 3-4 am I have quite a lot in my system with some at max strength ..... works for me as I always get Afib between 2 - 6 am.

[Hidden in reply to dmac4646]

Brilliant thanks - my bad time has always been at night. I quite like your regime particularly as you have tested it for 5 years.

[dmac4646 in reply to Hidden]

the only issues I get is when something else happens , cold , flu , chest infection , food poisoning , he tells me to take and extra 100mg if I feel these coming on , had I done so I probably would have had even fewer episodes but I have been slow to up the dose and then had to take the extra 100mg when AF started but , 99pc of the time it goes with in 3 hours ( which fits with the 3 hour lag in entering my system) - hope this helps in your discussion.

[Mike11]

I wouldn't think the NHS could set it as first line of defence as there are 100s of thousands of sufferers and nowhere near enough EPs to perform all the ablations needed.

But it is the only solution that really works.

[PeterWh in reply to Mike11]

They can and do. It all depends on the individual's conditions, symptoms, history, QoL, etc and also the EP's opinion. The assessment also takes into account other health conditions eg someone with or who has had liver problems will not be given a number of the drugs whereas some years ago they may have been.

[mikeymike7]

Hi Kbuck, I looked for alternatives online, took drug options(flecainide, amiodarone, bisoprolol, sotalol, warfarin, aspirin, atorvastatin and others I can't remember!) and lifestyle changes(healthier eating, losing two stone).

Result was partial success but AF got steadily worse over 5 years.

Was offered ablation early on (ie a couple of months after the first diagnosis) but too scared to have it. Finally went for it last January since when I have had two AF episodes. One within a week of the procedure, one in June. Both lasted less than two hours. Prior to that I was in AF for three out of every four weeks. Five years before that I was in AF once in every three or four months for a few hours.

Yes, the procedure/options will improve as time goes by but in the meantime you are treading water! The statin affected my liver function, the bisoprolol made me feel very odd, the flecainide worked well for a year, the aspirin gave me stomach issues.

Warfarin was fine and sotalol got the heart rate down when I was in AF and seemed fine too. Still have it as a comfort blanket PIP.

I'm not on any drugs now and my only regret is not taking the ablation route when it was first offered. It's all about quality of life and mine has been improved so much. Should I ever need a second ablation, I'll be there before you can say Jack Robinson!

[PeterWh]

Yes AF will only get worse.

The variables are over what time and the severity rate of increase. For some on here it appears that it can be quite rapid (ie over a matter of weeks or a few months) or over a few years. I have seen quite a few say they wish that they had had their ablation sooner.

Another thing to seriously consider when an ablation is offered is that at that point in time you are considered suitable. However if your AF gets worse in the future there is no guarantee that you will still be considered suitable for an ablation or whether other things will override.

Another key thing is that ablations are much more successful for those still in paroxysmal AF as opposed to those who are in persistent AF.