Ablations as first line response

I first went into Afib in April 2015 and have been in it 3 times since, each time I have been cardioverted back into NSR. The last time I went into a-fib I brokethrough 100mg/day of flecainide so have now started discussions with EPs.

I am 42 - healthy and reasonably fit, but do have a structural abnormality in my aortic valve which means I am at best only about 95% right (that's my heart, my head is less good!).

For some reason I was referred to an EP that only deals with ectopic heartbeat and he has referred me to someone who does Afib ablations. However, this guy told me about evidence that is suggestion ablations should be used as a first line intervention for a-fib.

First questions - anyone else heard this?

Second question - what is the "average" age most people get their first ablations. No offence, but I get the impression most people who discuss their ablations here are at least a decade older than me.

12 Replies

  • Hi I am 43 fit and healthy diagnosed withAf earlier this year

    Was offered cryo ablation but decided to stick with meds for time being

    Not sure of average age re ablation -good luck

  • Thanks. I should have added a point the EP made: afib begets afib. Keep that in mind if you have a breakthrough.

  • Hi Jonathon - I was 57 when diagnosed - but had AF for at least 10 years prior to that but just thought of them as palpitations. Had my first ablation at 62 - which made things a whole lot worse by the way - and 2nd at 64 which was successful and had no further incidents of AF since.

    I would point out that ablation has only been around for about 15 years so even if diagnosed earlier, ablation at a younger age wouldn't have been available,

    I think the idea of ablation as a first line treatment is very interesting and if it had been around and an option when I was first diagnosed I would definitely have jumped at the opportunity as I hate taking meds and I felt crap on the beta blockers and Flecainide, so my QOL was pretty miserable.

    I think it is a very personal decision and there is no right or wrong answer, you need to do what you think is right for you.

  • Thanks. I am on 100mg flec morning and night and beta blockers too. For the first few weeks on this regime I felt fine, but am beginning to think that was a honeymoon period. I don't feel terrible, but its more like I am not sure if i have a very mild flu or if thats just the meds making me feel that way.

    I would prefer not to have to take the meds, especially the beta blockers. From what the EP told me it seems like the sooner I get ablated the longer the ablation will hold.

    Why did the first ablation make things worse?

  • Can't say why, i can only speculate -- I felt so much better in the first week I definitely overdid things which wouldn't have helped, then AF returned with a vengeance, I had POTS and my BP plummeted so I had problems even sitting without passing out, so then HR hit the roof, ended up in acute cardiac unit with unreadable BP. After 4 days, 3 in the unit, suddenly converted back into NSR and BP went back to normal without any treatment.

    I am now pretty sure it was an autonomic dysfunction and evidently ablation is not recommended for those with dysautonomia. But I didn't know that then and EP advised a second ablation ASAP and as far as AF was concerned, I never looked back,

    I've had a few ectopic runs and some tachycardia but nothing that has been too troublesome - so over 2 years now and very pleased I was able to stop all meds 3 months after ablation.

  • If you look at NHS England ablation as a first line treatment is now approved by them (I think that was in 2013 or 2014). Previously they did not approve as first line treatment and recommendation was two failed medicine regimes.

    Yes you are in the younger end of the spectrum but younger people (incl 20s and 30s) are / have been on here and have had ablations. I suspect that this is partly due to the aging process that makes the heart more susceptible but also to do with the fact that people in their 20s to mid 50s don't think of heart issues if they are mildly symptomatic or they maybe asymptomatic.

    Personally I think that the sooner the better. As you rightly say AF begets AF.

  • Many EPs consider that ablation should be used as a first line treatment for AF where no other considerations affect the patient. i e LONE AF . ALL treatment for AF is about improving quality of life so especially for a younger patient, drugs which will have their own side effect and for a very long time seem an odd choice. Yes AF almost always progresses and the longer you have it the more difficult it will be to treat, People often used to say that flecainide lost its efficacy over time but of course this is not the case. What happens is that the AF progresses. Flecainide dose not have receptors in the body which multiply like narcotics so the body can't get used to it.

    Regarding age of onset, there was a pole done here a few years ago but I can't recall the results. Age does increase the chances of AF with one in four over 80s having it but as we know people can acquire it for many reasons. Amongst very young people it can be genetic, slightly older it may be body abuse either from binge drinking, over exercise or being a fighter pilot and then we start to get the age thing. One needs a predisposition to AF which can be genetic or as listed above acquired and to that one maybe should add NSAIDs as recent studies have linked long term use of these drugs with onset of AF.

    As mentioned elsewhere ablation and in fact any treatment of AF is new science. The first RF ablations were done in about 1995 and my first was in 2005 when there were still very few EPs in UK. I had to travel from Devon to London! Twenty years ago you would probably have been told, "it won't kill you get on with it" and be discharged. Add in GPs lack of knowledge (mine was miss-diagnosed for ten years) and you see that many people actually had AF long before they were diagnosed. Many ladies have been fobbed of with such as "it's your age", " It's panic attacks" and such for years. It is only the work of Arrhythmia Alliance and AF Association since 2007 which forced UK government to address this issue and brought AF a little more to the public notice.

    Yes many of us are older than you are now but if I'm honest I was probably in my mid forties when it started and I am now 71!

  • I was 69. My EP indicated that 80 was the maximum age for the procedure at his hospital.

    We don't really understand the long term effects of medication and the prospect of taking drugs for years is a worry.

    If you are offered ablation then you should consider it very seriously. I still have occasional mild AF and a second ablation is not an option for me due to radiotherapy induced fibrosis.

  • My EP had similar views and I was given the choice - meds or ablation. I opted for ablation and took bisoprolol whilst I waited. Ablation done in 2013 and clear since then. I was much older than you at 64 but I think bigger argument in favour of ablation if you are younger. It's a long time to take meds. Still it's an individual thing that you and EP need to decide together.

    Good luck with decision making as that's always the hard part 🍀

  • Thanks for all your replies. I nearly e-mailed the EP I am going to see to tell I have made up my mind and want the ablation! But I didn't send it. I should rather meet him and hear his views first.

    The EP I went to see has said to me a few times " you have to earn your ablation" ... well, I presume my 4 episodes of Afib in less than 18 months has earned it for me.

  • Hi Jon, I was 43 when I had my first and 44 when I had my second. I've recently had an episode of AF all be it brief. However, Flecainide as pill in the pocket pulls me out. It's been 4 months since my last ablation and my EP is of the opinion any episodes after the two month marker could be a Strong indication the procedure didn't work. He is happy to ablate me a third time, as several procedures are not uncommon. However, like you I'm a little worried being 45, even if another procedure gives me several medication free AF years, how does that leave me if I need further procedures down the line. I don't think there is a magic number you can have, but I'm a little wary. It's obviously a discussion I will have with my EP.

  • Hi I'm 36, had one episode of af at 21 and two episodes when I was 23 years old. Then nothing until 12 years later when it came back at 6 week intervals. Flecainide worked as a control but I detested having to take an anti arrhythmic drug at such a young age for the rest of my life. I'm fit, healthy but I do drink. Stress and alcohol a cause for me. Anyway, I requested an ablation after much consideration, my GP talked me out of it on one occasion but I knew it was the best course of action for me. Had ablation 3 weeks ago at MRI. It wasn't pretty as I had alot of pain, went into af during the procedure and it took 4 hours. I'd due it again though, but that's just me. I'm in the 3 month period now post ablation where anything can happen but after this I'm hoping to be af free and med free. If not we go again.....

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