Is ablation right for me ?

I am 62, overweight, with a history of High BP for 3 years mostly controlled by meds. I was hit suddenly with AFIB last October and spent my 62nd birthday in the hospital getting an electro-cardioversion which left me in normal rhythm for about 10 days before the AFIB started up again. I gave been in AFIB ever since, taking blood thinner and calcium channel blocker. I am struggling with the decision about ablation since there is only a 50-60% chance of success on the first try. I also have an "enlarged" (no idea HOW enlarged) left atrium and "moderate" mitral valve regurgitation. I read these problems tend to cause people to have AFIB. So... I wonder how the ablation will fix these problems? My EP is wants to do the ablation, but my cardiologist is pushing me to get a gastric bypass instead. That won't stop the AFIB , and I can't do two procedures at once! For now, the meds are keeping my heart rate under 100 MOST of the time, but my heart is constantly in AFIB (persistent). I am dieting and exercising trying to lose weight on my own. (Over the last 3 years , I lost 2.5+ stones and have kept it off... but I guess the cardiologist wants faster weight loss.) I want to make a good decision about the ablation. Will the enlarged left atrium and moderate mitral valve regurgitation reduce my chances of a successful outcome with ablation ? High BP (controllable with meds) and being overweight are my only other risk factors. Any input is appreciated.

24 Replies

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  • Weight loss significantly reduced the af episodes for me. Almost to a non existent occurrence but one 18 hour episode when I was fit was the final straw. So in a nutshell, improving your health will no doubt help the af but it's not gonna stop it completely. Your prone to this arrhythmia and if the meds don't control it, ablation is your best option and your only chance of an af free life. I'd get it done, so be it if it takes two attempts.

  • Ablation !! And ASAP.

    I have mitral regurgitation since birth and an enlarged left atrium due to a heart attack and my ablation 32 months ago was almost 100% successful. I was 100% until late November when a really nasty virus enlarged my heart further for a while but once clear of the virus just before Xmas I went back into NSR and am still there.

    But of course losing weight is important, and the best way to do this is to walk (or cycle if you want) long distances everyday so as to give your heart the exercise it needs. A gastric band won't do that !

  • If you are in persistent AF, the success rate for ablation is probably not very high and there are risks. In your case, if you are going to have an ablation, the sooner is probably better.

    In order to get some balance of risks v rewards, my EP asked me how much better I felt when I was in NSR after cardioversion. In my case it was "not much different" so my EP advised against ablation.

    Ablation is something EPs do so their tendency is always to recommend it - some more than others - though I have no doubt they believe it will help. In general, I would be inclined to take the EP's advice - especially over the advice of people on this forum! :)

    (Disclosure: I have no medical training!)

  • At conference last year it was stated that weight loss had a very high affect on reducing AF events. Weight loss helps BP and high BP adds to the AF burden. Leaking valves again add to the AF burden. Although a very great fan of ablation I do feel that some urgent weight loss will help you at this time. although you do not say just how over weight you are. That said thin people also get AF! My personal view with no medical background is that losing weight and getting down to a healthy BMI will help not just the AF but also your general well being. life expectancy and self esteem. As mentioned by Mike, a gastric bypass may not do this. Unless you have physical reasons such as arthritis which prevent regular exercise then walking or cycling are the best way forward. It is a simple formula. Fuel versus needs. You need to use more fuel than you put it and then you will lose weight. Regular walks in the fresh air will definitely help and add not only weight loss but fun to your life. Why not join the local Ramblers group and go out on a five mile stroll every week. You get a new social life as well!

  • Well, Cellolady I'm going to get tough here!

    All that extra weight you are carrying will of course put a strain on your heart! If you want a good quality of life and chance of better health YOU really MUST CHANGE YOUR DIET. See the words in bold, the choice is yours and yes YOU can have the will power to do this! Please take control yourself over your health and quality of life.

    For a start cut out all wheat from your diet, so perhaps porridge for breakfast and some gluten free crackers with cheese and an apple and banana for lunch. Then your normal dinner, but reduce the amount of potatoes/rice/ pasta you have with it. Also incorporate some form of exercise into your life, even if it's just walking to a local shop and then gradually build up to doing more.

    Come on you can do it to give yourself a chance of living a longer and healthier life.

    Please, please do it! You will feel so much better.

    Big hug and best wishes for success.

    Jean

  • You are so positive, how do you stay up there? I am 75 years old and overweight by approx 50 lbs. My BMI is 35. My A-fib started about a year ago but I didn't realizeit until four months ago. I thought it was indigestion or something I ate that caused my increased heart rate until it started to last for six to ten hours. You say weight loss will help but if that is the case why wouldn't my cardiologist tell me to lose weight or give me a diet of some sort to follow. I have weighed 242 lbs for 15 years now. I one of those people who love to eat instead of eat to live. Await your response, thankyou.

  • Ask yourself why you eat? Before you can reduce your weight you need to change your mindset - for life.

    The main reasons are - Emotional - Habit & Addiction (usually to sugar). The only way to change anything is to change your behaviour.

    Start small, reduce sugar intake until you have absolutely no added sugar in your diet but gradually to minimise withdrawal. Do one thing at a time. Increase your green vegetable intake until it is 50% of what is on your plate - starchy root veg don't count! Remember that sugar includes sweetness and honey, agave syrup, date syrup etc etc.

    Address the emotional issues & change your habits - this is lifestyle change and a want to live a healthy, happy life but you may need a bit of help along the way. As to why your cardiologist didn't tell you to lose weight - I would say if he didn't you need a new cardiologist. Cardiologists are not Nutritionists nor Dieticians - but you could go see one. Sometimes we have to proactive and not rely upon everyone else to be responsible for our help - we can be RESPONSE-ABLE.

    With crisis in healthcare in both US & UK we need to wake up to the truth that much (not all) of our poor health is self-inflicted and start to take action to help ourselves.

    A personal view - do hope you find some answers for you.

  • I've learnt the hard way about what food is and isn't right for me. In the past year I noticed that every time I ate a large lunch out and had wheat, immediately afterwards when I started to walk anywhere I would be aware of my heart thudding and then racing. It made me feel so ill I had no choice other than to watch what I was eating. I also noticed that if I ever ate cake my heart would thump. Now I've always been an extremely greedy person - I'm being honest here, but fortunately because I'm tall I've never been considered fat. I've always been quite sporty and active so I guess that helped keep my weight down. I had no choice other than to cut out wheat products, because it's scary isn't it when your heart feels as though it's trying to get out of your chest! Mostly through cutting out bread at lunch time I've lost half a stone. Looking back 11 years, my AF only started when I put on a bit of extra weight.

    I can tell you I feel so well now and I really want to share that feeling and how I gained it with others. Unusually for this greedy person 'me', I now don't miss cakes and biscuits. I'd never ever have thought that possible! I find also that as I've got older I can't eat such large main meals now anyway and if I overeat that's a sure way to start my AF off.

    It's also a well known fact that weight loss can help reduce AF. I guess some heart specialists may mention it and others not.

    The less you eat, the less you want to eat. The more you eat the more you want.

    In a nutshell, fear of my tachycardia and AF made me alter my diet. However it took me almost 11 years to eventually turn to the cure - cutting out wheat.

    Hope this helps.

    Jean

  • Jean,

    Thanks so much for the quick response. I have a doctors appointment on the 18th and I am going to approach him on this and just see what he says. In the meantime I am going to take your advice and cut out the wheat and try to exercise more. I felt that I have been pretty active by dong yard work, gardening and playing golf every couple of weeks. Are you still taking blood thinners or beta blockers now or were you able to get off medicine all together?

    Thanks,

    Ken

  • Hi Ken, I am by no means cured from AF but my attacks are so much milder and less frequent. I still have a way to go, I need to stop eating sweets every week! I take 2 x 50mg Flecainide and Warfarin (Coumadin). In myself I just feel so much healthier and alive since cutting our wheat products.

    Jean

  • So glad your feeling better, keep up the good work. I am going to try and emulate you. I will let you know how I things go, thanks do much for your advice and support.

    Ken

  • Sad to say but Dr amazingly do NOT always try to teach/educate. Calcium channel blockers have never converted or held my Afib, they only slow it down but also reduce blood pressure. Why have they not repeated the cardio version and used a different drug? It took the 3 cardio version in 3 months to even work, using a different drug (Rhytmol 225 mg 3 times a day) every time I went into the hospital to ER, cardizem has been used as rate control but has NEVER converted my afib. As I understand it, this drug works for some ppl. Try another cardio version using another rhythm controlling drug, ask your Dr. Best to you.

  • Unless you are 6' 0" you are 100 lbs overweight, weight is a big trigger for afib Australian studies show a big reduction in afib attacks after weight loss

  • Thanks Dave,

    I don't see any way I can lose 100 lbs. I am 5' 10", 75 yrs old with lower back problems. I do believe I can reach a reasonable goal which I will strive for. My question to you is, with weight loss alone will I be able to get off this darn medicine that makes me feel like half a person?

    Thanks for your imput Dave.

    Ken

  • Hi I was in af all the time even with cardiversions (3) the medication caused me to put on about rwo and a half stone. I had an ablation last January and have not looked back, nsr since. I have about a stone to lose but slimming world makes that very easy. I also walk about three and a half miles in.the morning at least four times a week. I know its hard but very doable with the right support. Just go for it and embrace a new fit and hwalthy life. Its fantastic. P.S. I am very near your age xx

  • Agree with others that the weight loss is important and although keeping motivated is sometimes hard, you can't eat much while riding a bike so keep gently active at first. Good luck!

  • I am also overweight (about 2 stone) but no bp problems. Also had slight enlargement of atrium and small leak in valve but still had ablation in 2013. I was 64. It took about 5 months for everything to settle down and i have been af free since then . i was very symptomatic so huge improvement in quality of life.

    I am now gradually losing weight. Walking most days helps general health but the main thing is reducing calorie intake and improving quality of food.

    I know its a chicken and egg situation. You need to do both but which comes first. My unqualified opinion is start your diet and exercise regime now, get a date for ablation and aim to lose some of the weight by then. Having the ablation should make it easier to walk and exercise so you could then continue to lose weight and become healthier.

    Good luck 🍀

    PS. Are you on anticoagulant

  • Yes, my doctor has me on Xarelto.

  • Just as an aside - exercise does not always help you to lose weight - obviously if you are sedentary and eat lots of snacks your input will exceed your output which will be stored as fat which results in unhealthy weight gain.

    Moderate exercise will help you to keep fit and help your heart healthy - 20 mins of moderate paced walking at least x5 a week - you don't need to sweat at the gym, unless you want to.

    80% of weight loss is due to eating less and eating smarter - reduce portion size, don't eat big meals in the evening, avoid starchy root vegetables & sugary things in the evening, everything you eat including snacks needs to have a balance of protein/carbs/plant based produce in the proportion of 25%, 25% & 50%. Fasting for really even short periods also really helps. Our bodies are not used to a constant conveyor belt of food - they cope with feast & famine a little better!

    Ensure you have a 12 hour window every day when you eat nothing e.g.:- if you eat breakfast at 8.00a.m. don't eat anything at all after 8p.m.

    I am really surprised at how just making those very small changes to what I thought was a 'healthy' diet has helped and I am now losing a steady 2lbs a week after a 2 year plateau and struggling to keep off the 20 lbs I lost 2 years ago.

    If you can avoid pharmaceutical drugs, that also helps as many of the drugs seem to promote weight gain, especially the steroids and beta blockers, but obviously some are inevitable and I take 3 with which I can't do without.

    It's HARD, HARD Work - but it is worth it!

  • I would do the ablation. I've seen numbers of 95-98% successful in the U.S.A. It is a much less involved and much safer procedure than an ablation, and you are ACTUALLY treating the real problem.

  • Good luck!

  • I am 69 years old and also overweight with Afib,one documented event a year ago,but on warfarin and metropolol. My EP told me he would not even consider an ablation until I lost my excess 50 lbs due to issues with possible bleeding in the groin area. This is much increased if there is excess weight,particularly in the stomach area.There are many concerns for heart health when carrying extra weight,but I gather the bleeding in the groin is a big deal due to the size of the hole punched in that area and the ability to stop the bleed after the ablation.It gives one something to think about seriously!

  • Every intervention is always carry benefits and risks which need to be balanced, losing weight when you are older is SO difficult but worth it if you can.

    Good luck.

  • Hello Cellolady, by now you would have some idea of what people think you should do. The question you pose seems to be conflicted with what your cardiologist thinks and your EP thinks.

    It is a good thing that your cardiologist recognises your excess weight is a problem, not all cardiologists or EP's for that matter want to admit that your gut is definitely connected to the episodes of AF...While you are considering your way forward please look up the Fodmap diet it is clinically proven and definitely not a fad diet, but a way of life.

    You are lucky you have no other heart problems because being overweight leans towards this. Personally if your Afib is bearable, I would consider the first way to go would be in loosing weight, either with surgery or non surgery. then tackle the AF with possible surgery.

    Either way you need to recognise that there is no cure at this stage for AF but the best way forward is for you to manage it with the help of your "heart specialists" and maybe a dietician. You could be instrumental in helping 'other heart conditions' I hope this helps with your decision

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