Mild paroxsymal AF - ablate or not ?

[jeremygray]

HI guys Id love some advice and to hear anyones experience on having mild occassional AF. Ive been offered an ablation but my AF is very short lasting - say up to a minute or five mins max and happens once a week or so. Its been going for nearly three years now and I am sure it was stress related - I have reduced my stress causes quite a bit now. I dont have any other illnesses such as high blood pressure which I know can make it worse Everyone talks about how its best to have an ablation early as its easier to do then - but it does come with complications and if you look at the papers only a small group of patients with no other illnesses actually progress to permament AF. So my question is has anyone just taken a wait and see approach and what happened ? Thanks for your replies Jeremy

[pottypete1]

I can understand your dilemma.

Medical considerations aside, it depends on your symptoms and how the PAF affects your quality of life.

Comparing the regularity and length of each episode of your AF and mine, what you experience is relatively mild and probably something that can be tolerated in the medium term.

However, if you want to accept that to ablate early is most likely to be the best medical advice and will provide the best chance of eliminating the AF, then I can tell you that having an ablation is very safe and has a very high success rate.

Having an ablation, whilst not a walk in the park, if successful, is worth considering.

Ask lots of questions of your EP.

Pete

[Roseyuk in reply to pottypete1]

I'd agree with above comment. Jeremy..

If it's mild and does not interfere to much with youre life..

I would hold off on the ablation ..

As it does come with complications..And not all first can be successful..

Believe me I know I have been through them.

Good luck and try to learn how to control youre occasionl A F

Doctor Sanjay Gupta has some very interesting videos on u tube I would definitely recommend.

[jeremygray in reply to Roseyuk]

thanks RoseyUK !

[jeremygray in reply to Roseyuk]

Hi. I've decided to hold off ! Still get bouncy heart rhythms once a day or sometimes less. But I feel relieved not to go through with ablation at the moment

[jeremygray in reply to pottypete1]

thanks Pete Yes I am considering it - especially when I am in AF like this afternoon and less so when I am not like most of the last 2 weeks ! JG

[pottypete1 in reply to jeremygray]

That's PAF for you. Your unhappy when you are in it being unsure when it is going to stop. You are unhappy when you are out of it because you are so scared it is going to happen again any minute.

Pete

[Hidden]

Hi Jeremy and welcome to the forum. Now that is not an easy question to answer because it's very much depends on so many different factors. Clearly you have done some research and you are aware that AF is generally regarded as a progressive condition. Are you also aware that the quicker most patients have an ablation, the more successful it is likely to be.

I'm not medically trained and would not influence your decision, but you appear to have sought professional advice so if you have confidence in your consultant, I would be guided by him/her. No doubt forum members will express a variety of different views which may help you to decide. In my case, I had a cryoablation just over a year ago and have no regrets......best wishes........

[RobertELee]

Clearly your quality of life at the moment is so little affected by your AF episodes that you are hesitating and that is perfectly understandable. But the reality is that it is unlikely - perhaps very unlikely - that these episodes will remain infrequent and of such short duration. Furthermore, as you age, you could well develop other issues which will combine with your AF and lead you to regret not having done something about it straightaway. Of course there can be complications with any type of surgery but catheter ablations are very safe and, while you may need more than one, very effective. But that effectiveness certainly seems to diminish the longer you wait. As with everyone of course, it's a personal decision you have to make.

[MarkS]

I'd leave it longer. Ablation success only really goes down when you become persistent/permanent and that seems a long way away for you. Improvements in procedures are taking place all the time. For other than top EPs, success rates are only 50% if that.

I'd concentrate on lifestyle changes now, they can have much greater effect on AF than ablations.

[Rellim296]

How much does AF inconvenience you? What sort of toll is it taking?

I'm sitting on the fence, waiting to see what happens next and whether the AF I get becomes tedious. I'm not displeased with my current situation as I'm far better off than I was a few years ago when I was much the same but my life seemed ruled by medication and I was taking the top dose of flecainide. I was able to give it up after my second ablation.

I've never found AF very burdensome and it doesn't affect my life too much, but I'm having much longer sessions than you every couple of weeks or so. They peter out and eventually terminate spontaneously after a few hours. My EP has suggested daily flecainide or a further ablation (I have had three) but has twice agreed to review at a later date. Actually of the two options I think I'd prefer another ablation. I don't think my family would agree with me.

[secondtry]

My money is with MarkS, use it as a wake-up call to look at all lifestyle aspects incl diet and supplements.

Before I was put on Flecainide 3 years ago two cardiologists and and an EP all said "Ablation now' but as I had vagally mediated Lone Paroxysmal AF with no co-morbidities I thought there was a good chance of postponing that (saving the NHS £15K!). I have worked hard on research and changes, results: may not have beaten it but have been AF free for 3+years and feeling increasingly better, working a full week at 63 & good QOL.

[doodle68]

Hi Jeremy You don't say what medication you are on at this time or your age which could affect your decision.

My PAF seems to be well controlled with medication at the moment (BBlockers which have bought down my high blood pressure and an anticoagulant (which I understand I will have to take for the rest of my life with or without an ablation) .

The PAF does not affect the quality of my life so I would not consider having an invasive procedure on my body at this time.

I think we all have slightly different versions of the condition and the decision is down to the individual, their symptoms and quality of life. .

This video makes a lot of sense to me...

youtube.com/watch?v=3VOq9BL...(Not working as expected?)

[jondeanp]

I'm currently on a waiting list for an ablation (since Sept '16), but am hesitant as to whether to go through with it once i do get the call

My AF is persistent once it does kick in. When in AF my quality of life is not drastically affected, apart from the fact that i am unable to do any aerobic exercise.

Like you i am reluctant based on what i read on hear of peoples experiences after ablation.

I feel i would rather not have any invasive surgery while the AF is not affecting my quality of life. Maybe in a few years, if my AF does become more difficult to live with, i would hope that procedures may have improved to give better outcomes

I have been AF free since the end of February and am able to exercise again

[doodle68]

....sorry my link didn't work .

It is by Doctor Gubta and called 'To have an ablation or not..that is the question'

I will try again.

youtube.com/watch?v=3VOq9BL...(Not working as expected?)

youtu.be/3VOq9BL7Y1U(Not working as expected?)

[jeremygray in reply to doodle68]

thanks doodle - i am considering booking an appt with him for a telephone consultation

[Mike11]

I'd get in the queue for an ablation and then ask to delay it if you're still okay when the time comes. The queue length varies depending on where you are but it's not like they are going to operate next week.

[jeremygray in reply to Mike11]

yes i agree - i am on the phone now to the hospital ! there are 200 people on the waiting list ! i suspect he only can manage a few a week - but they have now offered me the 15th August and I am in AF today after a stressful weekend ! jG

[Mike11 in reply to jeremygray]

I'd just take it then. They should manage 10 a week and there's probably 2 EPs so that's at least 10 weeks backlog

[Clareowenpearcy in reply to jeremygray]

I would go for it! It really is best to have the ablation before your Afib becomes more frequent. Unfortunately this is more likely to happen than not. Be prepared, it can take a second go around with the ablation as they don't like to be too aggressive the first time and often will go again after 6 months. This was my situation 7 years ago . Just had a 3rd ablation 2weeks ago.😄 Everyone is different though and I hope one will do it for you. All the best😄

[whiststev]

Hi,

I was in your position several years ago,with paroxysmal af with no symptoms ,very fit no other medical issues.My trigger was alcohol and 1 drink could trigger the af and yes I was given the opportunity of having an ablation because it was explained that this medical condition was most likely progressive. I decided not too, thinking I would be able to manage it on my own .Then July last year I went into persistent af ,although asymptomatic and managed by Flecainide prn I am now scheduled to have an ablation on the 28th. You can probably guess what my thoughts are now. This is my situation

Its your choice !

Regads

steve

[jeremygray in reply to whiststev]

thanks Steve _ I have been offered a date in August I am tempted to take it ,,, but scared ++++

[cat55]

Hi, As is often pointed out no two cases of AF present in the same way. This is my journey. Started with AF in 2001, we were living in Germany at the time. I had slightly raised blood pressure and was given medication. I was also prescribed Sotalol. I had a good GP and told her I was coming off it as it made me worse. Since then I have had at most 20 episodes of AF that I am aware of. I had a 7 day Holter monitor which showed many ectopics, every one of those I feel, but no AF. I take no medication for it, except pill in pocket Propefanone,which I have taken three times. For now I will stick with this plan, but should things get worse I will look at different treatment. That is just my take on it. All tests on my heart have come back normal. I try to keep my anxiety under control as much as possible. As I say we are all different. Good luck with any decision you take . Best wishes Kath

[jeremygray in reply to cat55]

thanks Cat

[UScore]

I am in a similar situation, although I have less frequent episodes that last longer. I've had 3 in the last year, and they self terminate in about 10 hours.

It looked like the common trigger for me was dehydration. I've been rectifying that since then, and after having 2 attacks in one month I've been AF free for over 2 months. I think it's too early, and not enough data, to say that my lifestyle changes have improved matters. But I'm optimistic. I'm not on any medication at all; I have PiP but not taken it yet.

I'm booked in for an ablation. My EP was very keen on it. I've got another appointment with her in a month's time and another opportunity to discuss it. I think there's a long waiting list so I'm expecting to be given a date around November.

I share your concerns. I don't like the idea of having someone poke around in my heart. I'm nervous about the procedure itself, and I'm also put off by the recovery. It sounds like it will be a tough few months. The longer I'm AF free the less I want to put myself through it all! Although I understand that the chances are AF is likely to return more frequently, and lifestyle changes can only delay that so much.

Most days I think I'll go through with the ablation. Other days I wonder if I should postpone. I expect my decision will be based on how many attacks I get between now and November.

Good luck, and let us know what you decide.

[jeremygray in reply to UScore]

I have been offered a date in August now. Today I am in AF after a stressful weekend I do get stress from time to time and it would seem as if getting it fixed in August woudl nbe sensible - especially if it will reduce my chance of dementia ! NO evidence of that being the case at the moment of course JG

[meadfoot]

Perhaps you could improve your lifestyle still further to see if that impacts for the better. Quality of life is so important. You could always discuss further with your medics to gain their considered professional advice.

I am sure your decision will become clear and you will choose the best path to suit you.

[jeremygray]

Hi everyone, I posted my question 15 hours ago and was looking out for messages on my account. Then I looked here and found 15 messages!!! Thats so kind of everyone !! I will digest and come back to you. Perhaps its an almost impossible decision to get completely right. I have done a fair bit of reading and have a medical background as well. I think the advise about lifestyle changes is important. I was very stressed at work and exhausted and getting lots of bumps and irregularities in my chest . I bought myself a heart monitor that fits onto my phone and I found that often I was in AF and often I wasn't - it was just ectopics. I can recommend this bit of kit as it gives you a diagnosis as well - you don't have to be a cardiologist to read it.

Anyway I digress - Since I have been off work I have slept and slept and recovered a lot of what had been 20 years of sleep deprivation and I am feeling a lot less stressed. The heart is so much quieter. But the dilemma remains - take the ablation now when its more likely to work or leave it because of the risk of complications and the feeling that if you don't have to burn holes in your heart maybe you shouldn't !

My cardiologist is open to either course of action. Its interesting this thing about AF begets AF and its become a bit of a mantra. However as a number of you have pointed out individuals with AF are a very mixed group. Some definately dont go into permanent AF even after many years. Working out whether you are in that group seems to be key - also whether there are any clues that you condition is getting worse and therefore you should act to get the ablation before it goes permanent. I think my cardiologist is in favour of acting now - to prevent the 'structural changes' that are talked about in the atrium that make the ablation more difficult 9but not impossible) when you have permanent AF . More to come but in the meantime thanks so much for replying - its great to share the worry

[pottypete1 in reply to jeremygray]

I have gone 25 years without going in permanent AF mine has been Paroxysmal but the truth is when mine started ablations were not an option.

My ablations only started 6 years ago.

I have recently converted to what seems to be permanent Atrial Tachycardia which I have been told is easier to treat

It has been a long and bumpy road for me which is why I believe you have been offered an ablation at what seems to be an early stage so don't dismiss it out of hand.

Having said that my personal view is that you should ask lots of questions of your EP if your quality of life is reasonable at present.

Pete

[djmnet]

Read the comments on this forum for awhile and you'll find that many posters have multiple ablations without a lot of success. Since your quality of life is good, you have no other issues, and your symptoms are very mild, this seems a drastic step to take. Also consider if your afib is ultimately found to be vagal in nature, ablation is unlikely to be the "cure" you're looking for.

[perkman]

Get the ablation. You have a higher rate of success in early stages. I opted to do that.

[jeremygray in reply to perkman]

thanks I am very tempted to do that now I have been offered a date

[marilynj]

I understand your hesitation. While I do not consider an ablation a 'surgical' procedure but an 'interventional procedure' very much like a cardiac catheterization with the intervention of placing a stent in an artery, it is not without risk of complication. I've had 3 ablations, my last with a serious complication. I was with a dr. and in a facility w staff ready to intervene in complications. Important. Check out both of these.

Just experienced short bout of Atrial Fib, lasting about 5 minutes. It's been 18 months since my last ablation. Will another ablation be indicated? I am one of the patients who can feel every irregular heart beat.

I think, if indicated, I would opt for another ablation -- my 4th ablation. Never stop trying to get this under control and be A-Fib free for the rest of my life.

[Slattery]

I have the same Afib that you are describing with no other health factors. My doctor advised me to live a healthy life style with daily excerise and no medications other than vitamins. Hopefully we will find out what is the cause of Afib over time with new procedures.

[Kastir]

Hi everyone,

I am new to this forum and love reading posts in this forum. I am a 42 years old healthy male, unfortunately developed Afib recently. I had two episodes of Afib a month ago and was put on beta blocker.

I spoke with one of my friend who is a cardiac surgeon about cardiac ablation and he suggested not to even think of it and try to deal with this condition conservatively. I also know one of my close friend who had a major stroke during cardiac ablation procedure. Secondly cardiac ablation does not guarantee that you will be free of Afib and no complications post surgery. Anyways, this will be your decision to do cardiac ablation or not but I have decided not to do any surgery for Afib and take medicines for the rest of my life even if it converts in to persistent Afib.

[jeremygray]

hi there Thanks for your thoughts Yes its a very difficult decision ! how are you getting on with the betablocker. I tried one and it worked very well for a few months but I then realised it was making me exhausted and I felt much better off it ! JG