I'm a relatively young person - 43 - afflicted with AF. I haven't had a definite bout of it for heading towards 3 years, after a period when I was having attacks every few months, typically occurring in the wake of running. (I do a lot of exercise, but cycling rather than running these days - I've only ever had one attack after cycling.) I'm on 2.5 mg of Bisoprolol, which I handle without any issues: I've been on Beta Blockers for a few years now, and to be honest I like them; I appreciate the way that they suppress nervousness.
Although it's been a while since my heart has gone haywire, I'm fairly confident that it will go astray again... And so I presume that, at some point, I'm going to face the question - to ablate or not to ablate..? Many other people have pondered that question, and the most obviously relevant considerations relate to the risk of having the procedure vs not having it.
Anyway, while looking up information about a book that I want, I came across a blog post by one of the finest living mathematicians, who also happens to suffer from AF, and who tackled the question whether or not to have an ablation in some detail, and in a way that seemed to me to be very illuminating. So - at the risk of posting something that has been posted before, which I hope isn't the case - here's a link to the relevant post: gowers.wordpress.com/2012/1...
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dommydops
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Like you, I was diagnosed at 43 (last year) , due to Bradycardia and sinus node pauses I was considered unsuitable for medication, thus had an ablation as first line treatment. The fears you express are something I think must be felt by anyone facing an ablation (regardless of age) and were certainly something that crossed my mind. I can reassure you, from personal experience, that I found the operation very straight forward and recovery quick (although as many people will advise, give yourself time to recover properly- I didn’t; going back to work after 3 days and resuming exercise mean that I am now waiting for a second ablation). I hope you find plenty of advice and stories here that help you with your decision. I wish I had discovered this site sooner, I think I would have benefited so much!
Mmmm... a few errors - first as Jenny already said warfarin doesn’t thin the blood - it prevents it coagulating and has absolutely no effect on the viscosity.
Secondly the catheter is placed into a vein - not an artery - it is a much more difficult journey to the heart travelling against the flow.
Making the decision as whether or not to ablate is a very personal one reliant on many factors which maybe be greatly influenced by the data you receive and the agenda of the person presenting the data - I have found.
I was told in 2013 that the chance of success for me was 99% - it made me worse but being an optimist and went again - believing things couldn’t get much worse now so what was there to lose. I, like you, had POTS and hypotension. I went again - the ablation worked, no AF, but I felt no better, in fact things got even worse symptom wise. Some weeks later I was diagnosed with a condition for which beta blockers, anti-Arrythmia drug, anaesthesia and sedation exacerbate. So things got a lot worse. No AF but extreme fatigue, sudden muscle weakness which affected every voluntary muscle in the body - and I am now finding out - can affect heart muscle - some people believe,
The variables of making a decision based on unknown unknowns are - unknown and we can only make a judgement call based on current knowledge and the known, knowns (Johari Window).
Given the same factors and knowing the outcomes would I have made the same decision? Probably as possibilities are just that - we live with uncertainty.
But I was having 3-4 episodes a week, I was very symptomatic and became exercise intolerant, couldn’t tolerate beta blockers at all and I was misererable.
In your position - I would also focus on investigating ANS - (autonomic nervous system - POTS & hypotension is a symptom of dysfunction and this area is only just being investigated with association to AF) improving vagal tone and any possible underlying conditions.
I would also suggest reading the article which EngMac posted recently quoting Dr Mercola on stroke risk factors, lifestyle and AF.
Currently we have too many missing bits which makes the decision you are now considering a difficult one,
One last point - you can live well with AF, you can’t always after a stroke and seeing what happened to your Dad will have coloured the lens you view from.
Very best wishes and let us know how you get on. I am sure many people on this forum will follow your posts with interest. CD.
OK I am breathing deeply and not getting too upset1
"When the pupil is ready the teacher will come" That is an old saying which is highly appropriate where AF is concerned.
When I was first offered ablation all those experimental years ago the idea and risks explained terrified me and I declined. My cardiologists merely told me that when I changed my mind as the AF got worse (and it did) to contact him again and he would arrange it. I went on to have three ablations before my AF went away nine years ago. Every moment well worth it.
Call me a cynic if you will but I believe that you are told all those risks only to prevent law suits against the hospital or doctor had they not told you every possible thing that could go wrong.
It's worth noting that the person who wrote the blog post - it's certainly not me, but rather this man en.m.wikipedia.org/wiki/Tim... - had an ablation: the whole point of the thing is that the risks involved in the procedure initially sound a bit alarming, but that, when they're weighed against e.g the baseline risks involved merely in being an over 40 and alive for a year, they don't seem like a very big deal. He just runs through the pros and cons in a highly rational way, and in a way that makes clear why the statistics relating to potential risks are prone to be misleading, because we don't tend properly to consider the risks associated with the alternatives. To be honest, it left me thinking that I'll almost certainly have an ablation when it comes to that!
try cardioversion first it worked for my family but everyone situation is different so only you can make the decision, make sure you check with your dr and other drs for more opinions.
The point about cardio version is that it indicates whether or not ablation may work - but if you have very occasional bouts which resolve quickly ie - within 24-48 hours - then unless offered in an A&E as an emergency it can be difficult to arrange, I have never, ever been offered one even after being in AF for several days and being an in patient,
I've got some flecainide to take if I go into AF, as a pill in the pocket: I took it under observation the last time my heart went wobbly, a few years back, and I was back in rhythm within a few hours. The longest bout of AF I had lasted a couple of days, but that was before it had been diagnosed properly, and they generally lasted for less long than that; the next time I go into it again I'll be quickly taking the flecainide, which will hopefully mean that I won't need electrically cardioverting. (My heart has always eventually righted itself so far.)
I think as your AF occurrence is so rare that I would not rush into an ablation. You could first consider what might be triggering inflammation. I suspect you're like me as you cycle and run and are relatively slim. So are you exercising too hard? I was and I've toned it down a bit now. I still do hills and longer rides but I don't do it against the clock like I used to. Is your dental hygiene good with no gum disease? That can trigger AF. Do you take magnesium supplements? Lack of Mg is very common and can cause palpitations, so a supplement is useful.
Ablation techniques and success rates are improving all the time, so if you do need one in the future then the chances of success will be that much greater.
Yes, thanks: when I saw an electrophysiologist a few years back, and I went in thinking that we'd be discussing ablation, he started accentuating the potential negatives of ablations, as he obviously thought that it would be wrong to rush into anything. The most obvious thing that triggered the attacks for me was running: every single attack that I've ever had, bar one, came on in association with running. So I never run for exercise any more. Running just pushed my heart much higher for much longer than cycling ever does. I don't take Mg supplements, but I'll look into them; I think that my dental hygiene is OK, but I'll look into the gum disease factor, too - cheers for those suggestions.
While I agree with you Mark, I was also surprised by John-Boys posts about his unsuspected AF during spin classes.
Maybe athletes don't always pick up on their exercise induced AF. And perhaps we miss nocturnal AF unless we are woken by it.
And again aren't athletes prone to cardiac fibrosis, independent of AF. The fibrosis can then be followed by AF.
Perhaps even a single episode of AF in athletes justifies a full cardio work up and referral for EP opinion.
Sadly it seems to me that anything more than moderate exercise may be harmful for some people. Perhaps there will be a genetic marker for that subgroup before too long.
AF is not really a burden for me. It's infrequent and goes away with flecainide.
But I like the idea of early intervention before it becomes more frequent.
I have successfully postponed my ablation a few times, but if I continue to kick the can down the road they will soon kick me off their list and I'll have to go back to the end of the queue. I need to decide very soon if I'm to go through with it right now.
I like how Michael Carrick, the footballer, has had the procedure and returned to training and hopes to play again soon. That makes me think I should just get on with it too.
The article that you referred was written in 2012 or thereabouts. Ablations have changed much since then. Ablation will probably be in your future. I was told that when it really starts interfering with your quality of life, it may then be time for an ablation. Everyone is different when it comes to afib/aflutter. I waited 5 years after my first episode. They kept becoming more frequent as is common. I had an ablation 6 weeks ago and I am very pleased so far. I am glad that I waited but maybe not quite so long. Dick
To Dommydops thank you so much for the link to the Gowers paper . It was very informative and helpful. I’m going for a second Ablation on the 21st Dec. And after having the first and being a little apprehensive, I’m ready. The first Ablation I was in permanent afib am now in paroximal afib, so hoping this one works.
Did you mean persistent because permanent, as I understand it, is the term used when patient and doctor agree not to do anything more. How long were you in persistent/permanent before your first ablation?
Not sure re persistant/permanent but I was in all the time for about 8 months. Seemed to happen after a really bad bout of flu which took about 3 months clear up.
Just had a call from the hospital cancelling my second ablation until the new year. Oh well at least I get to enjoy Christmas.
Hi, Yes , it did - I had a couple of attacks during 2018. None during 2019, though, and none so far during 2020, so the frequency hasn't gone up, thankfully.
I would not get an ablation if you can make lifestyle changes that would reduce or eliminate your afib. The risks that you take when getting ablated are real and serious. Though rare , when it happens to you it’s not so rare. I went for 3 ablations because I could not tolerate the medications and my afib was persistent. I’m just saying don’t run to get this procedure unless you have to.
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