To ablate, or not to ablate, that is the question....

Four years on from a successful first ablation for PAF at age 65, now in AF/AFL roughly half the time, day and night.

I used to be very anxious about episodes, but no longer am. The main symptom for me is feeling tired. I'm not sure whether reduced exercise capacity on the treadmill or rowing machine counts as a symptom.

I am seeing a new EP this week, and I imagine the question of a second ablation will come up. So I am trying to understand in advance what the benefit/risk of ablation is for relatively asymptomatic afibbers with good AC control and slow AF on Sotalol 240 mgs.

Some of the posters have gone down the serial ablation route, even 6 times for PAF. I wonder if some of you could kindly share why you chose to do that and whether you would in retrospect make the same decision.

What are the indications for ablation and are those indications justifiable, set against the inherent risks?

I am trying not to let my anecdotal experience of Staph aureus septicaemic shock soon after permanent pacemaker for PAF, cloud my judgement about invasive procedures.

My instinct is to man up, have the ablation and head back to the hills for some more adventures. Rather like Bilbo, though of course he was a hobbit.

[BobD Volunteer]

As I said in a different post. " when the pupil is ready the teacher will come".

What it is so important to understand is that ANY treatment for AF is only ever about improving quality of life (QOL) . If the burden of your AF is low then fine don't bother but if you are highly symptomatic, find drugs either have too many side effects , are not effective in control or are difficult to manage then ablation is a great way forward. That is why I had three before my QOL said stop. Should it deteriorate again then no 4 would be fine by me if my EP was prepared to go again.

It is a free world ?? well maybe so the choice is really up to each individual . The only right answer is what is right for you.

[Melleray in reply to BobD]

Totally agree with this. I have had 5 ablations and apart from the first one, which definitely did improve things, it is debatable as to how much the others have helped. I would also recommend trying magnesium citrate, as it does seem to help some people. I am taking it now , don't know whether it is having an impact as my AF is difficult to pin down and I could just be going through a dormant phase. I will keep going with it though.

[Hidden in reply to Melleray]

Thanks for your message Melleray. I am following your advice and have started Mg citrate.

I read your thread about anxiety with great interest and added a post at the end. A couple of things struck me. Perhaps the ablations have helped a little. It must be a bit unusual to have PAF for 18 years without progressing to permanent AF.

And I wondered whether Sertraline which I take for panic attacks might help reduce the frequency and severity of your episodes.

[Hidden in reply to BobD]

Thank you Bob for your helpful reply.

I wonder if stroke prevention could be considered a reason for ablation. If as we are told, anticoagulants in AF reduce the risk of stroke by 64%, then repeat ablation as necessary to maintain sinus rhythm might be justified to reduce the risk further.

Maybe AF treatments are not just about improving QOL but perhaps also about preventing QOL getting worse?

In which case relative lack of symptoms might be a poor reason not to ablate.

[BobD Volunteer in reply to Hidden]

Sadly Badger there is little conclusive evidence that successful ablation removes stroke risk. This is why many of us remain on anticoagulants even after our AF is put to sleep. Dr Gupta so eloquently put it It is not the AF that is the problem but the company it keep.

[CDreamer]

Bob’s post - succinct and to the point.

It is a difficult decision to make and one I think you need to be confident about. Everyone has personal factors which need to be appropriately assessed.

[Icenae]

I have sick sinus syndrome. 18 years. Pacemaker. had 3 ablations. I am 66 now. Was told i would need more after last one in march 2016. Was very unwell with pleural effusions after that one. So have tried the magnesium route. Af free for months now. How about try that first. See Sanjay Guptas posts. I take mag cit. by solgar from Amazon. 1 x 200mg dly plus another 100 g in a menopace supplement. So far so good. My consultant was sniffy and called it ‘The Continental Method ‘. Whatever. Has worked for me. My daughter nurse in ITU says they use magnesium iv for heart patients frequently. !!

Keep us posted. Best wishes.

[Hidden in reply to Icenae]

Thank you Icenae.

Yes I watched the videos on Dr Gupta's site and am taking Mag Citrate because so many people here have recommended it. Can I ask how long you felt it took to have a noticeable effect?

My mother had sick sinus syndrome and atrial fibrillation. She had several pacemakers over 30 years , took Digoxin, a diuretic and warfarin. She was active, going to London on the train regularly until she was 90, dying at 92 with aortic valve problems. I'm not sure an ablation would have done much for her.

[Laura914 in reply to Hidden]

Thank you for mentioning Dr Gupta. I went to his videos on YouTube and watch his Vagal Afib video and it fits me to a T. So happy to finally understand what is happening and where these scary Afib events are coming from. All the best Badger25

[Sunshine89]

Thank you for the question Badger25 and all of you who answered. This was very helpful to me too.

[Hidden in reply to Sunshine89]

Hello Sunshine89.

Your story sounds just like my mother's, her diagnosis was sick sinus syndrome, she had a pacemaker and medication only for her AF over a 30 year period. She was a tough old bird as we say, and outlived many of her doctors, bowing out at 92.

She never let her medical issues hold her back. Living through a Canadian winter I reckon you must be pretty tough too.

[Sunshine89 in reply to Hidden]

Hello back to you Badger25

I really appreciate your sharing yours and your mother's experience with me. It has given me real hope for the future. I am a pretty determined person who believes in pressing on regardless. Hopefully I shall prove as tough as your Mom. Although it is true that Canadian winters are cold. As a matter of fact I've just been out to take my dog for a short walk and had to cut it even shorter because, at -13c the ice on the ground proved a tad too cold for her paws. However, right now it is picture postcard pretty with snow covering everything, a clear blue sky, and bright sunshine glistening off the lake that I can see from my front window. I grew up in Manchester and found the wind and the damp unhealthy for me. Yes, it gets cold here but it is much dryer which I find way easier to live with. Spring here gets a wee bit damp but we have reliable summers and beautiful Autumns. Getting back to the issues of this forum... I lean toward your view on wondering whether it's worth the "stab in the dark" of ablation versus facing the risks of continuing with medication control. For me, as long as I feel reasonably well taking the Sotalol (40mg at present) along with warfarin I see no point in tipping the boat. Good luck to you, and may you live as long, maybe even longer than your Mom. Genetics play a huge role and medicine is improving constantly.

[Hidden]

Yes she has, thanks for the heads up. I sent her a PM yeterday