Should I have ablation for my AF !!?

Hello to all again ! . I was on dual antiplatelet therapy for some 10 year due to my under laying heart issues, until I was diagnosed with PAF about two month ago . Now I am on NOAC (apixaban) and aspirin , which I started some two and half weeks ago. My cardiologist has now referred me to an EP who I am about to see in two weeks time, suggesting I should possibly have an ablation . I am on beta-blockers and he thinks that I am not a good candidate for Flecainide. Reading the posts on this site I am left confused with the pros. and cons. of this procedure. Remembering that I had my first AF in Jan 2016 ( I think !! ) and the second about a month ago , my hesitation is because I have very little symptoms of the AF at the moment , my resting HR is 50-55 , and when I am in AF the heart rate goes up to 80-85 with unnoticeable irregular beats . The only way I notice is via taking my own pulse . I am 71 and quite active, regular gym goer 4 times a week and play tennis every week.

Your guidance will be very welcomed .

7 Replies

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  • Difficult one !! Your consultant will be the best to advise cos of knowing your personal medical background.

    As a general principle, I have heard consultants say it depends on whether AF is affecting your quality of life as to whether the risks of ablation are worth considering.

    Another, competing principle, is that if the AF affects your heart chambers' lining, you can get more AF so that early ablation can be wise.

    Another point is that you mention other heart issues- it may be these issues have caused your AF - if that is so,if these issues are treated and resolved might your AF also disappear?

    I don't think anyone on here can really know what would be best for you- I personally wouldn't be thinking of ablation if you have had so little AF and you can go to the gym, have such a low heart rate while in AF, and have only had two episodes BUT this is leaving out any consideration of your other heart issues ( does your consultant think AF will worsen these other conditions, for example ) and your doctor's assessment of what meds you can/cannot take, so that means perhaps going to see what the EP says and then decide. They should let you take your time and ask for ablation if and when you are ready.I discussed ablation with an EP and decided to wait. However, I don't have any other heart issues.

    I changed my diet to include a lot more food with potassium and since then have not had any more episodes. No doubt it may return as I get (even) older !!

  • I am a great fan of ablation having had three before my AF was stopped but I was highly symptomatic. All treatment for AF is about improving quality of life rather than cure so as I have said before if a person is not troubled by their condition one has to question the wisdom since there are risks in everything especially as you have complications .

    That said AF is almost always progressive and it is often said that early intervention by ablation stands the best chance of limiting progress and hopefully stopping symptoms. Difficult call and one you really need to discuss with that EP .

    Bob

  • You need to discuss the options. However regardless as to how little symptoms you have now you need to think long term. As BobD rightly says AF is almost nearly always progressive. However it is the rate at which it gets worse can be so variable and the rate can suddenly increase in an individual. Also you are fit and healthy now. However in a few years time you might not be quite as fit and that could mean they say you are unsuitable. You could also quickly flip into persistent AF which reduces the success rate. Also you might have developed other illnesses which mean they say no to an ablation even if those illnesses aren't life threatening. Also as BobD says early intervention gives the best chance of success.

    In my case I had been only very mildly symptomatic (I had put the symptoms own to other things but in retrospect they were AF) and I was in persistent AF. Then over the course of less than a year my AF became significantly worse and affected me very much more in a number of different ways.

    Personally if they offer it then they will think you are a suitable candidate and it will benefit and so I would take it.

  • If it's offered, I'd go for it, as Peter says. Your situation may be different by the time you get to the top of the list.

  • Iam not a doctor but I take Apixaban and on the box it says do not take aspirin ??????

  • Thank you for all your comments , extremely useful and fruit for thought for when I meet with the EP. My previous heart issues were initial heart attack in 2005 , had then the new drug eluted-stents which caused in-stents thrombosis which required heart by-pass 2006/7. Since then I have been lucky with very little problems until now with AF. I will use your remarks to form questions for the EP at our meeting and will report back . Clearly the progress of the AF is an important factor in this decision . If there are members out there who have experienced asymptomatic PAF which has progressed to more problematic AF , I would like to know the time period and possible signals ?

    I take your point Mazza23 , I had little choice it was a toss up between Plavix or Aspirin with NOAC and both cardiologist suggested on reflection Aspirin the better option in my case !!

  • I am not a fan of ablation, however I wouldnt advise anyones decision either way out of respect for dealing with this horrible condition. Just a few things to keep in mind.

    The older we are, the less successful ablations are.

    More likely than not, one and done has a very low success rate. You will most likely need at least 2.

    You havent had that many and alot of those after ablation battle PVCS, PACs and tachycardia the rest of their lives.

    New studies are showing some serious cognitive issues with white spots on the brain unexplained and a certain risk of brain bleeds. Radiation levels are 50 times higher than acceptable levels.

    A large % of those ablated are still subject to a regimen of meds for life.

    I sought out alternative over 2 years ago with great success. Its not easy but with so few episodes, what do you have to lose?

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