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Paroxysmal Atrial Fib not converting.

This is my first post and I found this great site by mistake. I have had occasional bouts with Afib for about 10 years and I am 49.

I get the classic flutter and then I'm thrust into an episode of Afib for the next 24 hours and it usually subsides on it's own. These episodes are usually precipitated by exercise, alcohol or stress but they never last longer than 24 hours. After an episode, I generally wont have an attack for another 3 months. During an Afib episode I usually take a full aspirin every four hours or so until converted.

(Yes I am aware that aspirin is not recommended for Afib but my physicians said it was fine for now.)

I have seen seen two Cardiologists having every test known and a CHADS score of 1 due to hypertension (controlled). My EP Cardiologist wants to do a PVI or Ablation but I am still on the fence since my Afib only occurs 4-5 times a year and converts on its own.

I guess I'm playing a waiting game as to when PAF or even Perm. Afib begins to control my life more than Paroxysmal already has to this point.

Should I consider a an anti coagulation agent since I'm in Afib several times a year and go ahead with the ablation?

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Hiya Mark, I can understand you playing a waiting game. But from my point of view ... are you asymptomatic ...... that is can you be in AF and not know it. I am one of those weirdos. 'cos if you are that spins the dice entirely and it ceases to be a waiting game but a high risk game - risk of a stroke, and just 'cos you are only 49 doesn't make you immune to a stroke. What damage has been done to your left atria (I think that's the one), 'cos if it is damaged it may cause pooling, which can make its unwelcome contribution to a stroke.

On the other hand if you don't know the answers to these questions then I'd suggest you find out the answers. Your Cardio Consultant would be the first one to ask.

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Thanks for replying, I'm just now catching up on emails etc.

I'm the type of person that knows immediately any changes in my heart rhythm whether it be fluttering, pvc's etc... I guess its possible to not know I'm having Afib. Each time at the cardio doc my ekg shows NSR.

I'm only hesitant for ablation because of the riskes I've read online. I know there are risks to every aspect of life but this is an attention grabber. My EP wants to anticoagulate a couple months prior to and after the ablation.

I'm just uneasy about being on blood thinners.

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Hi Mark !i have been on warfarin now for the past six years ,up to now no ill effects ,have had a past ablation for the A/F which cured The A/F for eighteen months ,I am due for a further ablation in a months time ,there was no problem with the ablation only bruising in the right thigh .I am 78 years old .

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Welcome to a place that we would all rather not be in!!!!

First thing to address is Anticoagulation. I personally think you should definitely be on one of them. I agree with carneuny. A stroke can hit at any age and I knee 2 people who had strokes at around 40; 2 or 3 in their 50s and then quite a few more 60+. One lived for 17 years paralysed from the neck down and could only grunt. His sister said brain was 120% there.

With AF the risk is 5 times higher than a normal person and although the risk is small at 49 it is still 5 times and you don't know how often AF is happening because it is a fact that you can have BOTH symptomatic and asymptomatic incidences even in the same day. Also over 60% of all fatal and major strokes are suffered by AF sufferers. This was only found out 5 or so years ago.

Secondly re an ablation. One big unknown is how quickly your AF will progress (increase) and ultimately go into persistent. The success chances of an ablation when in persistent reduce. I was already in persistent AF when diagnosed exactly 2 years ago. I was almost asymptomatic (few minor things which I now know are attributable to AF). In that 2 years my quality of life has deteriorated significantly. Have to sleep 2+ hours every afternoon and much longer at night.

Feel free to ask questions on here as people are very helpful. Above all read all the info on the main AFA website and certainly print some of them off.

Good luck!!!

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Hi there Mark. The theory is that if you have AF, your risk of stroke is increased, regardless of how many episodes you have or how often they occur. For people with AF who are over 65 anticoagulation is recommended, but for those under 65 anticoagulation will increase their risk of a haemorrhage. So some younger people choose anticoagulation and some do not.

AF progresses and 4 - 5 times a year may, sooner or later, become monthly and it may no longer terminate spontaneously. The more entrenched AF is, the harder it is to treat.

In your position, I would tend to be more enthusiastic about the ablation than about the anticoagulation. I personally find an increased risk of bleeding quite scary, although three years of successful anticoagulation have made me much less apprehensive than I used to be. You will find a lot of support on the forum for anticoagulation for the under 65s.

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I'm 41, and had AF for 18 months, Mine is pretty minimal, 2 episodes since diagnosis which have been very brief and converted quickly on they're own.

I'm currently not on any anti coagulation due to my chads score of 0, however if I were to get a score of 1 I wouldn't hesitate to take it, maybe even one of the newer ones.

I've decided it's ablation for me as at 41 and with hopefully a few years ahead of me yet, I'd like to get a chance of getting shot of it

A video put on here recently of prof Richard schilling saying younger people are choosing ablation which carry up to a 80% success rate of being successful rather than a life of drugs, some of which I believe are quite toxic.

I wish you well in your decision,

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Question is (and the one I would be asking) why does your EP want to do an ablation? Quite often it used to be the desperate patient wanting the ablation but I have noticed recently that sometimes the patient is less keen than the EP! There are several reasons I know of but I read somewhere (can't remember, sorry) that after about 15 years of PAF it is likely to become Persistent and then you may be keen but it will be much more difficult to treat.

So I certainly agree with Carneuny, unless of course you have had a full discussion already and are looking to us for our personal opinions and experiences?

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Mark

The key answers to the questions raised by Buffafly are that it is now recognised that EPs now recognise (as BobD says) that the earlier intervention stops it in its tracks and as I mentioned it is more successful. I also suspect that the younger you are the more likelihood of success. Also until recently EPs and cardiologist believed drugs were the initial best way - but they hold the symptoms but do not cure or reverse the AF. Also in the last few years Amiodarone (which was one of the two main drugs of choice)has been downgraded to minimalistic use (basically four to six months with the ablation after 1 month) and Flecainide has more side effects than originally thought. Another key factor I suspect is the decision by NHS England that ablations could be the first form of treatment and not two long term failed drug regimes. Therefore EPs can propose the best course / option that they think is appropriate for the Add to dictionary

Not sure where Buffafly gets the 15 years from. Although I don't know when exactly I started paroxysmal AF nor when I went into persistent one doctor did say you can go into persistent in the matter of weeks.

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My EP initially wanted to do the ablation over a year ago but I hesitated due to some of the unknowns.

Anticoagulation is an issue for me for two reasons. One being the bleeding risk and the lack of an antedote with the newer meds. Secondly I don't have a desk job, I work in a demanding field of oil drilling and the risks are abundant. Although I do have a few older coworkers that take blood thinners for various reasons.

So initially I balked at the ablation for the above reasons and some of the risks involved with the surgery. I just don't know how common they have become as time marches on.

Has anyone here ever heard of (Atrial esophageal fistula)? apparently it's a very real and fatal issue with ablation.

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Yes, but they can use a thermometer to monitor the temperature of the oesophagus, especially if they are using a laser. Something of a challenge to get it in situ, accompanied by vile banana flavoured stuff that numbs the throat and works a treat.

You have a long list of dire complications to contemplate when you give consent for an ablation, but - should any of them happen - you are in the right place for them to take measures to prevent any damage. There's a team of about six to look after you and one lady told me that she would be watching me like a hawk all the time for any sign of anything untoward. Very comforting. I have had three ablations but only one using a thermometer.

As I said above, I found the bleeding risk very worrying when I was persuaded, aged 67, to take an anticoagulant and I really didn't like no longer being a normal person. It can feel like a no win situation and you can feel damned to bleed to death if you grasp the nettle and damned to succumb to a stroke if you don't. Doom and gloom. I decided that death was better than existing pathetically with a seriously debilitating stroke, so I went for the anticoagulation, feeling life didn't stretch out in front of me for more than a very short time. Months? Weeks? Too optimistic, as the stroke would happen tomorrow if I was lucky enough to last the night. It wasn't a happy time. I felt I was doing the right thing but was far from comfortable about it. I'm older, more at risk and much more blasé than I was back then and on a NOAC (Rivaroxaban). The absence of an antidote is not a concern at all, partly because when you cut yourself, the blood doesn't actually gush like you think it might.

Actually I was 66, not 67 when anticoagulation pounced on me and took over my life.

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Thanks for your insight. I have an appt Monday with EP. I suppose I'll have the ablation performed, I still have reservations but they will pass.

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The rewards, for me, have made it feel worth taking a slim risk of something dire happening. I've not actually shaken off AF, but I am substantially better off than I would have been.

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Firstly with a Chads score of 1 anticoagulation should be seriously considered. Aspirin is worse than useless since it still possesses the ability to cause you harm. whilst doing nothing for stroke prevention.

Secondly AF is almost always a progressive condition so far better to stop it in it's tracks before it becomes established and more difficult to treat. If your EP offers it he thinks it will help you. At your age I would want to avoid a lifetime of drugs frankly but it really is up to you. Anticoagulation is not an option but a necessity regardless of the outcome in my view.

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Don't forget to consider "pill in the pocket" flecainide. It works well for me and remember that the longer time you spend in af the more likely it is to recur, so you really don't want those 24 hour runs.

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I have never been offered a pill in the pocket option, maybe because my EP know that my episodes subside on their own. I just converted to NSR today after 37 hours in AFIB, it just goes away as it began.

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Have you had a 7 day continuous heart monitor? This is a bit of a bore to wear but the Only way you will know how long you are in AF for.

My view is that the only reason to take any drug is 1) to prevent death 2) to improve quality of life.

If you can cope with the episodes and don't feel ill, my advice is avoid the drugs - all EXCEPT anti-coagulant.

The period of highest risk of stroke is not when in AF but a period covering on converting to NSR up to 10 days following the episode.

You could also avoid triggering of AF by changing your lifestyle and if you need the motivation go to drjohnm.org/2015/02/a-new-w...

Lifestyle changes are the most effective way of improving wellbeing - ablation for 'fixing' AF and the sooner the better. Heed Gracey's testimonial below!

Best wishes CD.

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I have worn a Holter Monitor for 24 hours to evaluate occasional PVC's and whether they were contributing to the onset to an AFIB episode. I didn't realize there was a longer term holter monitor.

I have read at length Dr. John M articles, lots of good info.

Typically when I enter an Afib episode, it lasts 12-24 hours and rarely 36 + and these episodes happen 3-4 months apart for whatever odd reason. Binge drinking always brings on an episode and I try to avoid too much alcohol.

Correct me if I'm wrong, but my cardiologist said Afib would need to be present at least 48-60 hours before a blood clot could form. I know aspirin is frowned upon for Afib but I normally load up on it during an episode, absent a blood thinner.

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I understand that NICE's withdrawal of the use is aspirin for those with AF as an anticoagulant is because it doesn't do that but it is still used as its an antiplatlet. Also taking loads increases bleed risk.

You can identify some AF periods because of symptoms. How many other AF incidents are you having that you don't know about because you are asymptomatic?

Thinking and knowledge has changed in these areas in the last few years in particular regarding blood clots and Anticoagulation. Currently there is no such thing as Anticoagulation as a PIP.

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I spoke to my EP recently who said that the most often time for stroke after AF is up to 10 days. Blood may pool and The clot may form in the appendage of the left atria after 24 hours in AF but I don't suppose there are any clear lines as everyone may be different.

As Peter says, aspirin may do much more harm than good as it is an anti platelet which helps stop platelets from clumping, very different to clotting. Aspirin can be helpful after some other heart events such as Heart attack or AFTER stroke, but does nothing to prevent it forming.

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I would strongly suggest you request the pill in the pocket as you are very likely to be able to abort your long runs of af much sooner

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Hi Mark and welcome. I have been on this forum a lot lately like you asking questions. I've had PAF for over ten years and on Flecanaide all that time with dosage increasing over time.

I have turned 66 and with that Magic number I got an anti coagulant because CHAD score went to 2( over 65 and female). I've been taking Pradaxa with no problem and like you I dislike taking it but now he may save my life.

I am relying to you not to tell my story but mostly to help you with your decisions. It's a very scarey journey we are on but there are many of us to support you. You have read all the pros and cons for many more informed than I but I believe that although medicines and procedures help we also have to do our part in managing our health. I've been scheduled for a Cryoablation and am now questioning my decision. I have become very proactive about taking care of me. I have dropped weight, and stopped eating gluten and processed foods. I'm not sure if this is a cure for me but I haven't experienced an episode for over six months. As I noted, I have PAF so going months isn't unusual but I can say there is something different. I feel stronger and less tired and above all more in control of me. I have even cut my Fkecanaide in half, instead of 300 mgs daily I'm done to 150 and in normal rhythm . I'm now unsure if I'm ready to get the Cryoablation because I have read that there are studies that say by lifestyle change you may stop your AFib. Not kidding myself, they also say that also with lifestyle change and ablation you have best chance. If you read some of the recent posts you will be able to read what all the brilliant people have written on this forum. I hope that I was able to help you in your journey to feeling well. We are all here for you, Gracey

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To update: I had a prior appointment with my EP Cardiologist today and I have decided to go forward with the Ablation for which he refers to a pulmonary vein isolation. I'm tentatively scheduled for November 30th and he has started me on Apixaban (Eliquis) 5mg twice daily to be stopped one day prior to surgery. I'm nervous but relieved that I have taken the next step towards alleviating these unwanted Afib attacks.

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Take proper anticoagulants, you are at risk.

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