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AF Association
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Wondering whether to have an Ablation

Hi All, this forum is very useful and is making me rethink my current ablation decision. I have had one significant episode of AF in Jan 2017. I was put on the regular meds: apixaban, bisoprolol, amiodarone and was cardioverted the same month. One shock was enough for a NSR and no issues since. I had a stent in 2011 and a pacemaker in 2014 and am physically active and suffer no side effects from the meds (other than tinnitus which started a few months ago- linked or not?). At the last appointment with the cardiologists he decided to reduce the amiodarone to 5 times per week. I pushed back a bit on the long term use of this med since apparently it can affect other organs. He suggested I see with the electrophysiologist what other options were available and the EP recommended ablation. I initially agreed, but after reading all the potential side effects of this procedure, I am wondering whether it would be wise to wait and see whether the AF comes back. One year without any AF as confirmed by checking the pacemaker (my personal monitoring station :)) makes me wonder whether it was a one-off event. I have already reduced the amiodarone to 3 times per week and have suffered no adverse effects so far. The GP told me to come off it altogether, but the cardiologist did not agree. I also felt he didn't really think ablation was the way to go but didn't want to contradict the EP. All a bit confusing, but one way or the other, I have to make a decision to keep my ablation appointment in March or cancel it. Any advice from anybody who has been through the same experience would be welcome.

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I have to tell you that ANY and ALL treatment for AF is only ever about improving QOL (quality of life) so if your AF burden is light then I would question the wisdom of ablation . On the other hand Amiodarone is such a nasty drug I would want off that ASAP. As was said at this years conference Amiodarone does not have side effects it has effects!

That said I always tell people that the only right decision is what is right for them. Just don't ever look back and regret, Make your choice and move on.

( I had three ablations before my AF was sorted with o problems by the way).

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Hi Chesson, most of us here will understand your dilemma. As Bob says, it's all to do with improving your quality of life and after weighing up all the options, only you can decide the best route for you. Amiodarone is an effective drug for sure, but you are right to be concerned about it's long term use. Cardiologists love sticking in stents and EP's tend to favour ablations and often have different views, but they are the experts on arrhythmia and their opinion has to be worth listening too. I'm no medic, so I don't know if your history of heart problems would be an issue, but as long as your EP has taken it into account, I would be inclined to follow his advice. Many say AF will get worse over time, but again that is not the case for everyone, but if you decide to go down the ablation route, it is deemed better to have it done sooner than later......good luck.....

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If you've only had one episode of AF then Bob is correct as that is a very small AF burden I think you need some further opinions as Amiodarone is usually used where nothing else is effective as it is quite bad for one in other ways.

I could have had an ablation but knew my episodes didn't warrant the risks involved. Various life style changes and my episodes are now much less frequent- and I take no meds at present other than Apixaban

Take your time and try other routes and meds with medical advice

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Yes rosy,i too have resisted ablation after many years of the coming and going of AF.

Medics said it would eventually be permanent which it seems to have but together with the advice on this forum and natural treatment it is more subdued and I am presently cutting back on the medication (but not the apixaban)

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There is no RIGHT decision in the absolute. I had PAF with an event only every 18 months once I discovered it. Meds can take care of things for a long time. NO doctor can tell you when it will get worse, but it ONLY gets worse with time. I decided to go with an ablation when the events came more often. The longer you wait the worse it gets the less likely the single Ablation will be successful. That is what drove my decision. Good luck. It is all personal risk management.

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I've got tinnitus with Apixaban and others have as well. Mine is constant but not too loud, and I've become used to it, so it's not a problem at the moment. Although last week it became much louder just for one evening, then back to normal now? First time it's ever done that and I remember thinking I'll have to change drugs, but as I said, it then went down to normal, so sticking with Apixaban for now.

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I'm going for ablation (I think! I've changed my mind a few times on this so far, but this is my current decision!).

I've decided this because I'd already made lifestyle changes over the last 10 years; I'm vegetarian and avoid processed food and too much sugar, my BMI is about 23. I gave up smoking over 10 years ago although I wasn't a heavy smoker, I only drink alcohol once or twice a week and very rarely in large quantities. I go to the gym regularly; but don't do the same intensive workouts I used to do.

Despite all this, AF still visits. So I feel ablation, combined with a continuation and possibly even more improvements in lifestyle, give me the best chance of stopping or slowing the progression of AF.

The decision is different for everyone. All the factors of the decision, the severity and frequency of AF, the triggers, the possible lifestyle changes, your age, etc, these are all going to be weighted differently by all of us. There is no wrong decision really. I like Bob's suggestion of making a decision and then only looking forwards. You make the decision based on the information you have right now, not hindsight.

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One episode in a year, it's a no-brainer you must have QOL therefore the risk reward of an ablation is not in your favour. However, you have 'medical history' and that's where I, as a non-medic, bow out as that could change things.

A couple of extras:

EPs do ablations and my cardio cautioned me, "if you go to a carpet salesman you will buy a carpet."

Yes, I agree with others, earlier ablations are likely to be more successful but I think this can largely be countered (if you are optimistic) by the procedural improvements as time goes by, with always the promise of something non-invasive on the horizon.

Best of luck with your decision and I hope it won't, but if it goes wrong either way, don't beat yourself up as no one including the medics can say it wouldn't have been worse choosing the alternative i.e. if you get my drift you will never be right or wrong - ironic, the choice of treatments is almost as frustrating as AF itself.

Healthy New Year!

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Thanks to everyone for their helpful comments. I think what is really holding me back from the ablation are the comments from many people on this forum who had multiple side effects from the procedure and took a long time to get back to "normal". When you are currently suffering no episodes of AF and are essentially going into an ablation to avoid the long-term negative effects of the drugs (particularly amiodarone) , it is hard to go into a procedure that may well make you significantly worse for an unknown period of time. I would be really interested to hear from those of you who have had an ablation and how long the after-effects of the procedure lasted. Happy New Year to all.

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For me there were no definite after effects of my first ablation 4 years ago. A recent echo showed significant atrial wall scarring which may or may not have been worsened by the procedure, my PAF pre ablation being substrate dependent.

The problem is that people with bad experiences will always be over represented in forums like this, whether the subject is cars or ablation

There is no substitute for properly designed retrospective studies or prospective trials, with appropriate statistical analysis, and those are relatively thin on the ground. Happy ablatees have often moved off the board.

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My EP said amiodrone is a drug of last resort so it sounds amazing you are on this with only one episode. I had an ablation in nov 2013 which was successful and I have been af free since. However I was having episodes 4 or 5 Times s week each lasting at least 5 hours.

I would not go for it if I had your history and would not take amiodrone. Nonprofessional opinion only!!

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Hi I have PAF had 2 stents 2002 good result .Been having PAFabout 20 years with lots of symptoms and episode s lasting 6 days at a time .July2017 had cryo ablation with some problems still have PAF but its so much less symptomatic so QOL has improved,so no regrets about my decision.

My EP has me on waiting list for Radio ablation to try to improve things further, but must admit not yet fully on board as I am feeling quite good QOL at this time, so still pondering on that.

But whatever I decide I will have no regrets,I will just move on.

Good luck with your decision making.

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Medics tend to believe that they are expected to offer 'something', so the option of 'doing nothing' may well not be considered, but it is the EP who is the expert, not the cardiologist (he is a 'plumber' not an 'electrician'). Hospitals need to turn you round quickly, so may use amiodorone - but they then don't see you again - It is left to your other doctors to help you sort out if that is really the best long-term medication.

So why not listen to your GP who probably wants to spare you all the possible complications of amiodorone (eg other illnesses with their effect on Quality of Life)? There are other drugs which could replace the amiodorone in the long term which you could try, and you may not need them anyway.

If it was me I would definitely want to get the GPs help in coming off amiodorone, and then take it from there - ie. find out if you really have a long term problem, and how bad it actually is, before making a decision for ablation - or for other drugs.

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If it were my decision, I would wait. The ablation procedure is very safe most of the time. Every year, however, they make improvements to the procedure. My episodes started as once a year for 2 years. After 5 years they increased in frequency till they were every 4 days. The ablation, at least for now, stopped the afib mostly. I am glad that I waited but maybe not quite so long.

Good Luck Dick

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I’ve got a February date for an ablation, however I haven’t convinced myself that I want the procedure right now

I have persistent AF but it doesn’t really affect me apart from reduced physical exercise

I think, like you I’m concerned about the post ablation symptoms vs my current AF symptoms

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Life is bliss since my ablation....... Do it.

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