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I just don't know wether to have ablation or not

Hi

I'm a fit 52 year cyclist.

Here's my story.I had my first af episode in September 2016.

I then had no more symptoms until a year later ,September 2017 ,at the time i had had a fantastic summer of cycling,completing Mont Ventoux and several 100 mile rides.

After then i have had an episode about once a month/6 weeks that lasts up to 12 hours and then dissapears until the next episode.

It seems to be continuing in this manor/frequency

I'm still riding my bike and feel great.

I have seen a consultant cardiologist and electrophysiology consultant.

They don't want to put me on a beta blocker as it will affect my cycling and have given me the option of an ablation and left it with me to make up my mind.

They have said here is nothing sinister going on and are not worried about the AF but more the symptoms.

To be honest i just don't know what to do.

I would be grateful to hear anyone's thoughts?

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your problem is that, as they'll have told you, the AF comes with the cycling!! I don't know- and probably no-one does- whether it would return after ablation if you keep cycling. I'll let others who have had an ablation advise!! Good luck!

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My AF was 24/7 so not the same at all, but after my ablation I could do anything and without any drugs (except anticoagulants) for 8-10 years. My EP has always said best to nip it in the bud if possible.

Having said that, I had a nip-it-in-the-bud ablation when my AF came back just a little bit 8 years after the first successful ablation, and they couldn't get me into AF when on the table, so they had to abort ! I think from what they said and their reaction, that this is pretty unusual.

If my EP said an ablation would help me, I'd have one without much thought. I'd like to be off my drugs even though they are working pretty well at the moment.

Good luck whatever you do.

Koll

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Hi Islander. Just before reading your post re 'to ablate or not' I happened by chance on Dr Sanjay Gupta's video on ablation. (He is a cardiologist in York and also has a website. I offer this information because initially I was confused as to who he is. Here in the US we also have a well known MD named Sanjay Gupta who is a neurologist and well-known commentator on CNN.) So someone kindly explained this to me and now I'm usually referring to Dr Gupta in York. I watched his video with interest and thought he had a lot of knowledge on the subject of ablation. For some, it may be too technical. I understood it prob because I am a retired nurse. But the most important thing I got from his video was very simple: For me, info re surgery/ treatments/meds/etc must help me answer two basic important questions for myself. 1) Will this (fill in the blank) help me prolong my life? 2) Will this (fill in the blank) maintain or improve my quality of life? These two questions can be mutually exclusive and at some point we have to answer these questions for ourselves. Let me share MY answers. Your answers may be totally different. I would be willing to prolong my life IF it helped me keep my definition of a good Quality of life, For me I do not want to be in a nursing home at the mercy of others and without my full mental faculties. Easy, done! I did have an AV node ablation with a pacemaker insertion and it has gone well for me. But that's ME. Always do what will make YOUR life work best for you. Hope this helps. My 2 questions have made quite a few medical questions almost easy for me. Thanks for listening.

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Hello Islander, welcome to the place you would rather not be. It is a difficult dilemma deciding what to do for the best and the only thing you can do is research the condition as much an as possible, and of course, draw on the views and opinions of others in similar positions. You are probably aware that extreme sports such as cycling , marathons and the like can cause AF for younger people and I guess at some stage, you will need to decide what is more important, your ongoing health or pursuing a sport which is clearly important to you. Some people decide to go for the ablation option and are able to continue with their sport but we are all different. There are no guarantees an ablation will stop AF for ever and there is a real possiblity that extreme sports activity will bring you back to square one, but that is something you should discuss with a medical professional.

In general, as has been said, if AF is causing quality of life issues, ablation treatment tends to be more successful if undertaken sooner than later. Other considerations include the possibility of remaining on fairly potent drugs for the rest of you life which could be either reduced or even eliminated after a successful ablation. Generally, but not always, AF starts like yours ie paroxysmal (comes and goes) and over time can become permanent ie 24/7, which sounds bad, but the body can adapt and many folk lead normal lives but perhaps not performance cycling! There are so many things to consider, I'm no enthusiastic cyclist although reasonably fit for 71. I decided to take the ablation route and have no regrets but it was not a decision I took lightly......good luck

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All very good answers above and I think cover most aspects

There are two important facts to remember apart from what has been said about sport being the reason for your condition. Two groups of people tend to present at younger ages with AF and they are athletes and fighter pilots, both due to over working their hearts.

The first thing to point out is that because of the affect AF has on the atria it tends to be almost always progressive.

The second is that ALL and ANY treatment for AF is only ever about improving quality of life (QOL).

Ablation may enable you to put off progression for a while but there is no guarantee that it won't come back again in the future, especially if you don't modify your life style. This form of treatment has only been around for about 25 years and long term data is still hard to track down but if you manage ten years AF free that would be a good result. I'm at nine and a half by the way but while I have no AF I do still get other arrhythmias from time to time.

I know how much hobbies mean to people and would be hard pushed to give up my motor sport activities unless I knew that it was making me ill so only you can decide which way to go. I declare an interest here as an ardent fan of ablation having had three before my AF was stopped but recovery from this procedure may take a lot longer than your doctors tell you. The heart takes three to six months to fully recover as those of us who have been there will attest and trying to rush back into sport will only risk ruining all the heard work. Also nothing in life is without risk so again one has to balance benefit against risk.

Bottom line is the only right answer is what is right for you.

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Thanks Bob for taking the time to reply.

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Hi Bob You said what I was trying to say re QOL only you said it better and more succinctly.

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I agree with the posts above. For what it is worth Bob is right. My heart is taking a long time to get over my ablation on the 23rd Oct but it is getting there. I am now having days with no AFib which is wonderful but still have a few ectopic and irregular beats but most of the time now feel OK which is something I have not been able to say for 3 1/2 years now. I am hopeful that everything will settle down nicely. Most people seem to be able to settle down much more quickly after an ablation.

If you only get your AFib when extreme cycling then for what it is worth I would have thought your long term health is more important. You will find that as you become older there are more and more things which you can no longer do which you enjoyed in the flush of youth. I am afraid you just have to accept it.

I loved skiing and was very good at it (I always said it was the thing I did best, off piste, deep snow, black runs) but to my great regret can no longer go up into the mountains with my silly heart.

The older you get the more doors are closed to you. You can however do other fun things. Life goes in phases and you have to accept that or become miserable.

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Hi islander52 :-) I am afraid 'to have or not to have' is a decision only you can make and a difficult one with possible risks whatever you decide.

If I was 52 and facing years of medication and not as I am approaching 70 having had P-AF for many years I would opt for an ablation if it was offered. I know it doesn't guarantee an end to AF but on balance I would give it a try .

Good luck whatever you decide to do and you can count on support here...:-)

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I hadmy ablation when I was 72 and will soon be 74. For me, getting off my cardiac meds and the side effects I had from them greatly improved my quality of life. Glad I did it. And if down the road I need a 'touch-up' I'll do that too. I hope I never need cardiac drugs again.

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Thank you so much for all your replies.

It seems as though in a round about way a lot of your thoughts are directed at having the procedure.

Yes the point has been raised by my both consultants that as a tall skinny endurance athlete i'm a text book case.

Time to get my thinking head on.

thanks

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At 53 as a keen recreational runner, I developed AF which slowly became more frequent over the following 18 months until it started interfering with my running.

I opted for ablation for QOL reasons and now, 4 months later at 55, and with no regrets I'm back to running and enjoying doing so.

As an objective measure, for the last 5 years I've been able to achieve 5k in 22m and a half marathon in around 1h40. I'm back to to doing 5k in just under 24m and whilst I'm not yet ready to try, I reckon I could currently manage a half in around 1h50. I think it's still too early to say, but I'm hopeful that I'll make it back to sub 23m and 1h45 and I'll be very happy if I do.

Whilst I've had no AF since the op, I'm experiencing plenty of ectopics which remind me that may not be far away from a recurrence of AF. I'm hoping that will subside over time. I've also found that my HR range is reduced since the op, before it was 55-195, currently 65-185.

Steve

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Hiya islander52

I’m 55 the drugs that I’m on at moment I’m not tolerating well at all . I have a cardiologist app next week and I am going to talk about ablation as I would like to work again it’s only been since Oct 16 diagnosed but been going on since 2011 , I’m not all clued up on this but one thing I do know is I want to be able to work or hoover without feeling rubbish , or one day without a headache . Most of these letters I don’t know all these abbreviations are , but because I’m young I would like to at least be more able as now I can’t .. sitting around all day is not for me .. but my brother aged 58 died from Islamic heart disease he didn’t know he had it so I’m not going to push myself just doing what my doctor (GP) has said , including contacting cardiologist and talking about this ablation . Only you can decide good luck .

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Afib will not kill you but symptoms can knock you out. Cycling does seem a trigger for afib. If you are healthy otherwise and you have a top EP and hospital I would consider an ablation if offered.

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Hi Islander,

Similar to you, I was a long distance cyclist having compiled over 8000 miles in one year in 2015. At age 58, I experienced AFIB symptoms on two consecutive rides, but my symptoms went undiagnosed even after a series of tests which did not detect AFIB. After a break of one month, I went back on the bike and experienced no more symptoms for 10 months. Then once again, AFIB came back and I was finally diagnosed on my first of three trips to the emergency room in one week. I was put on meds for three months and resumed riding but AFIB kept coming back. Had an ablation shortly thereafter and resumed cycling and AFIB was back in 6 months. Had a second ablation 8 months after the first one and now am AFIB free. I still get ectopic beats which require continued low level medication but no AFIB. Also, I’ve cut way back on my cycling in terms of mileage, speed and frequency

Two points: I’m afraid to say that you may need to seriously consider paring back the length and intensity of cycling whether you choose an ablation or not. Once you have AFIB you are always susceptible to it again even if you have an ablation. Long distance and intensive exercise are known contributors to this nefarious condition and not a good idea once diagnosed with it as I’ve learned the hard way. Additionally, even if you feel you can manage the AFIB for now, it may deteriorate over time. Second, you may potentially be putting yourself at the risk of stroke unless you explore getting on anti coagulants especially of if you either are not taking meds to control AFIB or having an ablation. AFIB and stroke go hand in hand. Please talk to your physician to explore your options in terms of the best treatments for you

I’ve been through This and it was difficult for me to moderate my cycling as I am very competitive. But, managing my AFIB and quality of life are more important.

Best of luck.

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Another 58 year old cyclist here. I was not offered the ablation, instead I am on Beta-blockers and Flecainide. The only issue I have is the b-bs make it hard to stay warm in the winter. No more long distance for me just go far enough to enjoy it, then home.

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It may be you need a pacemaker added to the mix. Talk to your doc. I have a pacemaker and although I will always be in an afib state- my ekg's always read 'abnormal rhythm' the pacemaker along with the av node ablation keeps me symptom-free. It's a demand pacemaker and keeps me beating along comfortably at 70 bpm. Even when I get 'discombobulated' over something my rate rarely goes past 75-76 and comes down quickly.

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Just like me, my VF and frequent PVCs came with my "extreme" running and hiking habit. Almost died, 50-60% skip beats. Four months later after my four hours long ablation, I started running again, but this time I do it slowly every day. And now, two years later. I don't have any skip beat 24x7. Listen to your EP, you will be fine. Good luck!

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Hi bellchu can I ask who and where did you have your ablation had 2 failed last year my EP said mine was complicated and a 3rd may also fail, on meds but thinking if a more experienced EP could perhaps find the tricky pathways I seem to have,

Many thanks Ingrid

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My situation was a little bit special. I was in Shanghai two years ago so I had the ablation in Shanghai and my insurance covered everything. My EP Qunshan Wang was the professor at Shanghai Jiaotong University, he has countless patients, I think he's very experienced. researchgate.net/scientific...

Although I could fly back to Canada to have the free treatment, I still think it was my best decision to have the ablation in Shanghai. Think about the huge amount of patients they need to deal with every single day, you can imagine how experienced they are. Plus the medical system is blazing fast in Shanghai, you don't need to wait for too long for the ablation. From the first day they put me on the waiting list to the end of the treatment, it only took me a week. But in Toronto, it would take you around 1-2 months.

AF ablation should be easier, it usually takes less than 2 hours, the point is to find the right spot to burn. You should have considered changing an EP or hospital when you had the 1st ablation failed. It's like playing video games, it failed because the EP didn't find the right spot to shoot.

Good luck!

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Thanks for your reply Bellchu that was incredibly quick for your ablation I have been told I have to wait at least 1 year for my ablation here in N Ireland as my private insurance wont cover! My EP felt my ectopics came from the moderator band and this was a fairly new discovery if I thought I could be "cured" I would fly to Shanghai despite my fear of flying! I had 5.5 hours in theatre and was devastated that things were more or less the same and also recovery was slow I'm amazed at the things people can do after their ablation but I suppose everyone is very different. Many thanks for your reply love hearing about good outcomes keeps me positve!

Kind regards Ingrid

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Hi Bellchu, I am also a Canadian living in British Columbia. My family doctor kept me a whole year until I got into persistent AF to even refer me to a cardiologist who then refers you to the EP. The timeline in referral from family doctor to get to see an EP is horrendous ( 7 months) so that I had to talk to the manager of the cardiology department to get that appointment reduced to 5 months. The stress and agony to get this appointment took its toll on me for I had researched the rapid deterioration in AF. From EP appointment to an ablation would take 3 to 6 months and beyond. By that time I would be hitting long-standing persistent which is much, much harder to ablate.

I was considering Toronto but had difficulties researching exactly where to go.

So I went to Bordeaux, France which is considered tops in the world, and it is the institution where the ablation technique started. The time from application to ablation took one month. Thus my total time in persistent AF took six months (of which only one was for Bordeaux)

The Canadian system kept me so long causing my heart to deteriorate so much that I had to have two ablations, for according to Dr. Haissaguerre, the outstanding doctor who invented the technique, 4 rotor areas beyond the pulmonary veins develop in the first six months of persistent AF. (The second ablation was for atrial flutter).

Pulmonary vein catheter ablation takes "less than two hours" as you say, but persistent is anywhere from 6 to 8 hours. Atrial flutter ablation is generally in the below two hour range.

Canada has a long way to catch up in treating AF patients. The cost of each ablation was 16, 555 euros for a total of $50,000 Canadian. I had no private insurance to pay for the procedures. British Columbia does not allow private AF clinics.

Also, the total Bordeaux procedures were superior to that which I could have got in Canada, so I am more than glad I went. The journey was from my bitter experience in Canada to the excellent, expertise , procedures in Bordeaux. In conclusion, I made my situation special.

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Hi islander

I was diagnosed 5 months ago and have been in persistent AF since. Cardiologist reckons I could have had it for 18 months/2 years beforehand. I had no symptoms before I was diagnosed and no symptoms since. I found out by accident when I got a bee sting. I am 57, keen cyclist for last 20 years and have ridden 25,000 miles in last 5 years, lots of long rides etc. I am now on Bisoprolol and Rivaroxaban.

The advice I received from my cardiologist was to definitely carry on cycling but not to "strain" when trying to keep up with the group particularly when riding uphill. So this is what I'm doing, I ride a lot more on my own, I've dropped my average by 2 mph and I hold back going uphill. I feel I could go quicker sometimes but I don't. I'm still aiming for 100 miles per week this year but, you know what, I'm enjoying my riding just as much if not more now. It's not a question any longer of head down and trying to keep up with the group, its head up and admire the beauty and scenery around me! And I'm still in persistent AF and still asymptomatic apart from the odd palpitation. And I'm still getting a lot out of my riding in terms of fitness, weight control etc. I have cut out caffeine and reduced alcohol by about 80 %

I will be having an appointment with EP soon to discuss option of Ablation and, as I have discussed on this Forum before, I will have great difficulty deciding whether to have an Ablation or not! I'm different to you as I'm in persistent AF' (1 successful CV lasted 4 days).

All I can say is that I feel my heart won't "wear" out while in persistent AF even if I keep riding the way I do. It just behaves in a different way than normal. This was emphasised by an EP I think he was at a support group in Exeter before Christmas during a presentation (BobD was there as well). He too stressed current QOL factors should be considered carefully when thinking about whether to have an Ablation or not.

So I don't know if all this helps and I know I will be faced with the same dilemma as you soon, but we and many others have lots to consider.

Good luck

Ian

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I have only had two afib attacks in two years so my cardiologist said it wasn’t needed as my medication was keeping it under control and there can be problems associated with ablation but then I am not a cyclist but if your cardiologist suggested it then maybe you should take his advice

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Well, it seems clear doing nothing and suggesting your reduce cycling performance are not options. At this point, I think you are favouring an ablation, so If I was you I would be revisiting my cardio/EP and quizzing them hard on the likelihood of the procedure reducing your cycling performance including any drugs they would recommend after it is done.

If the answers you are given don't sound reassuring, I would first test out if you can go on an old tried and tested drug for Lone PAF such as Flecainide and at least buy some time until the EP's get more experience with ablations or a non-invasive device comes along (ref to Dr Sabine Ernst's comments a while back). I was 60 with Lone PAF with 55 pulse and 115/70 BP when I took the latter option and my cardio didn't give me any BB's or other drugs; what followed was 4 years and counting of no AF, however lifestyle includes no performance sports. Good luck!

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You're not going to like my advice but if even if you have the ablation, keeping on stressing the heart like you are will simply cause more chaotic electrical pathways to form and you'll be back in AF again. I'm afraid the human body isn't designed to be as fit as you obviously are at your age so maybe you should be considering the flatter classic rides such as in Belgium or Italy ?

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I would try moderating my cycling before taking any action such as ablation - you would have to for 6 months anyway post procedure - if no AF it makes your decision clearer. But thats me !

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Hi Islander,

Two years ago, I was in exactly the same position as you, except that my episodes were very short and I assumed it was simply down to losing fitness because of my age. This all changed when my AF changed overnight to become persistent; which was when I was diagnosed.

I was put on Beta-blockers and anticoagulants to manage my HR peaks, and continued riding, but shorter, slower and with no inclines. A cardioversion proved that I could maintain NSR, although it failed after two weeks. My QoL could not be maintained (cycling adds greatly to this) without an ablation; I was programmed in for a hybrid ablation with 3 months of amiodarone in between. I had the surgical ablation April and the catheter ablation in October last year. I am now off all medications and pretty much back to normal. I still have a few ectopics and have not yet returned to serious cycling, but I expect to be given the all clear in April.

I don't intend to return to competition, but I do expect to get out with the sunday club runs. Feel free to check my previous posts for detail of my treatments.

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John, at last I have read a favourable experience with a hybrid ablation. I’m due to discuss my situation soon with my ep after he has seen my ct scan. Did you have ct scan? Anymore info on your hybrid ablation would be so helpful. Thanks in advance

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I had an ECG which confirmed AF in March 16, an echocardiogram in June 16, a cardioversion in October 16 and the two ablations in April 17 and October 17. A lot of the detail is in my previous posts, but a lot more is on afibandcycling.wordpress.com

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I suggest you look at this website, and try reading his book: drjohnm.org/

He is an EP and keen cyclist, and writes about AF and sport. It may help you decide what is right for you.

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I am surprised you were offered a Beta blocker rather than flecainide. Flecainide might work for you without impacting the cycling. However AF comes with increased stroke risk, although probably not huge for a young (ish) ultra fit person.

The evidence is that even if the AF is controlled by drug(s), the risk remains. There is good clinical evidence (but not yet definitive proof) that a successful ablation reduces the extra stroke risk back down to that of a similar person without AF.

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I’m 37 yo cyclist about to have my first ablation in 3 weeks. My AF has affected my ability to cycle, hence the ablation was an easy decision for me. In 2016 I also cycled Ventoux and 2 days later La Marmotte ... fast forward 18 months and I’m struggling to cycle 6 miles to work!

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Did you mean you struggle to cycle 6 miles to work even you're not in afib?

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With or without AF, due to total loss of fitness!

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