AF Association
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Too late for ablation?

With PAF since 2001, under Propafenone until 2015. Nowadays Amiodarone and Pradaxa. I am 64 and slowly my AF is getting worse.

Two remarkable EP have different opinions: one of them understand that it’s too late to proceed with an Ablation due the the years passed since the AF appeared. He believes that every AF episodie makes a very microscopic scar in the Right Auricle, and through the years AF begets AF due that reason.

On the other hand, a second EP suggest cryoablation with 60% of success the first time and 70/80% the second one.

Any suggestion will be welcomed.

Bests wishes,

FW.

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Mmmm...... points on both sides - I think you might have meant atria not auricle?

My understanding is that the longer you have had AF and the more progressive and the older you are is the less likely ablation is to be successful but I’m not sure the issue is that polarised as described in your post and they are opinions. How you respond as an individual cannot be predicted. All you are getting is their particular view, based on their particular experience with their particular patient.

I would also take into account the ablation success rate of the EP - which is extremely variable anyway.

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Sorry, I meant left atria/auricle.

Thanks CDreamer for you suggestion

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Is your AF persistent? ( there all the time} The FRAME system of scoring can help you see the chances- if you email your address to me on PM I will send you the details

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Hi Rosy

I have persistent AF for about the past 2 years according to estimate by the Cardiologist. Would you mind e mailing the FRAME scoring system to me? ian.greenaway1@btinternet.com

Many thanks

Ian

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all done!

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Great to see the old terms in use. We called them auricles when I did anatomy 60 odd years ago but now it is atrium / atria and it is the left which is the problem not the right. Left to you by the way looking out.

Both have a point but if you are greatly troubled by your AF I would try ablation.

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Thanks for your point of view, BobD. I was wrong, I meant left atrium/atria.

Regards,

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Never sure why they changed the term but auricular fibrillation doesn't quite have the same ring as atrial fib. lol

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May need RF ablation also as cryo will just do the pvi. At this point most likely have areas outside the pvi that will need RF. So cryo for the pvi along with rf for any other hotspots.

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Wise words. Thanks for your explanation, now I totally understand one EP point of view. Regards

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Not at all sure about it being too late.

I have had AF since 1984 and had my first ablation 10 years ago when I was 61.

Although it has taken more than one procedure for me I am now a lot more stable.

None of my ablations were cryoablations so I cannot comment from first hand experience. I do know that they ablated not only around the pulmonary vein but also on the roof and back of my heart. Despite all that my super electrical impulses managed to find a route around the inside of my atrium, hence my multiple ablations.

Despite all the years in AF I was not told I had extensive scarring until recently and it has not discouraged different EPs from trying to make my QOL better.

I think that CDreamer has a very good point about the experience of your EP.

All I can say is my EPs (yes more than one over the years) have not ever told me it is too late and I am 71 in April. As recently as December I was told by my EP “Don’t worry I will not give up trying”. That is all anyone can ask.

Hope this will give you confidence to persevere.

Pete

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Hi Pete,

I guess QOL is the major issue for most of AF patients. Everyone of us wants to improve it, and each experience of members of this Community, helps to find our own way. At the end of the road, the question is if Ablation will improve QOL before no medication will work. Finally the “attitude of confidence to persevere” now I realize that should be improved in my case. Thank you.

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I had an ablation in Dec 2015 when I was 71, not totally 'cured' but no meds except Rivaroxaban and the couple of episodes I have had have been very mild. I was 'threatened' with amiodarone if I didn't agree to ablation pronto as my EP considered that persistent AF was soon likely. Amiodarone is considered the drug of last resort and often only used to 'prepare' a heart in persistent AF for ablation.

I would ditch the doommonger and go for the ablation (s). You have nothing to lose except a poisonous drug! Hopefully you will be able to manage with something kinder to your body even if the procedure is not completely successful.

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Forgot to say, I had been diagnosed with PAF for the same time as you and was also taking Propafenone but with Diltiazem added.

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Thanks for sharing your experiences, Buffalo. Slowly I’m changing my mind trying now to stop Amiodarone and be more confident towards Ablation. Regards

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Great reply and would be my answer too if I didn't try to straddle the fence so much! My QOL is much better off the drugs.

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I think you have advised your own answer when you said your AF is slowly getting worse. What will prevent this happening ? More meds or an ablation? I have only had PAF less than 3 years but I had an ablation at the end of Jan as my AF was "evolving" and getting worse, more frequent episodes that required more drugs which I do not really get on with. Unfortunately when the pulmonary vein isolation stopped the AF I then developed flutter in the right atria ( possibly caused/ made worse by the flecainide i am on for the a fib?) . So i have had an ablation for that as well a month ago. I have had no arrhytmia since then but am still taking meds for another month when my EP has said I can come off them.

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You are right, KMRobbo, I wrote my own answer but I didn’t realized about it. I guess some fears regards ablation procedures and some nostalgic view of the man I use to be before AF are involved. Thanks a lot.

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After living with affib for about 20 years I had my first successful ablation. Successful in the fact that I was pretty much affib free for 5 years before I started to have occational bouts for the following years up to present day. Had second done in January.

That being said I would not discount the chances of success.

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Nice approach to my situation, rocketrich. I’m becoming more optimistic about my future. Thanks.

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I have been a cardiac patient for 20 years after two MIs (1998,2005) and an out-of-hospital cardiac arrest (CPR by a bystander sustained me until an ambulance arrived with an AED ). I had an ICD implanted. AF afterwards was successfully suppressed by increasing the ICD pacing to 70bpm. This changed 4 years ago when the AN told me that I now had paroxysmal AF and I started 5mg bd Apixaban. Two years later I had persistent AF. The curious thing is that I am always unaware of the AF. The only way I know about it is when the AN or the pacing clinic tells me what has been recorded in my ICD’s memory.

My GP referred me to be considered for catheter ablation, but my EP said that ablation was much more complicated for persistent AF. It would probably take about 3 hours and would only have a 50% chance of success. He thought that, since my AF is asymptomatic, it wouldn't be worthwhile for me to go through such a procedure. I am 77 and generally fairly fit. Perhaps I have “missed the boat” for catheter ablation and will have to just put up with the AF until it progresses to a more debilitating stage.

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Thanks, white6540. As my AF is very symptomatic, I should seriously consider ablation procedures before it’s too late. Regards

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Get a second opinion if you want an ablation and my persistent ablation was way longer than 3 hours.

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I had a cryoablation last April when I was 66 it only worked for 9 weeks and then the AF came back more frequent than before. Saw my Ep in July for 3 month follow up and he suggested an RF Ablation as soon as possible. I had second ablation in August last year and so far 7 months on and no AF and I only take Rivaroxoban. If I had to have it done again I wouldn’t hesitate.

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It’s my more likely scenario, Nanabrodie. Two ablation was the last EP suggestion. And the fact you have no regrets of your ablation decisions is very useful for me. Thanks

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Your welcome. Good luck

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Just my opinion but I don't feel odds of 60 to 80 % with one to two ablations are such bad odds. I am biased as I had an ablation with pacemaker in 2016- am currently 74. Aside from feeling much better than I did on meds, I am currently off all cardiac meds. I had side effects no matter what meds they tried. I would also read the posts here of people who have had ablations and pay special attention to their age and length of time they have had (diagnosed) a-fib. I believe many of us had a-fib long before we were diagnosed. I believe I did. I just thought my rapid heart rate was anxiety. It might reassure you about what is best for you. It might be interesting as suggested if you could find out more from the 2 EP's re what's behind their thinking other than what they told you. Could be good or bad experiences that has made the conservative one hesitant. Good luck. It's a hard decision either way. Keep us posted. Take care. irina1975

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Thank you again, irina1975 for your kindness and warm response.

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You're very welcome. irina

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I believe both EPs are right. AF is associated with microscopic changes in the heart tissue which probably are cumulative and contribute to additional AF. Note, based on animal models, it may be these changes may be reversed by the novel anti coagulants, eg, abixaban. I do not know the present status of this research. Moreover, the underlying cellular cause of AF still remains a mystery. So, who can say how much AF induced change to the heart is too much?

The second EP who advises ablation is offering you a chance to get out from under AF. It has some risks, you may need two ablations, you may still need anti-arrhythmic meds afterwards, but you may live well for years free of AF post ablation. No one knows ahead of time exactly how well you will do with ablation. In your shoes I would go with the ablation.

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Hello Tojo2020.

Last Monday I went to my old clinic cardiologist who is helping me to decide. One year and half ago he suggested me not to have an Ablation. But now he changed his mind, as procedures are more safe (and perhaps my symptoms are worse). Although he thinks AF symptoms will return, nobody knows how long will take. But during that time, I may improve my QOL.

More or less your thoughts.

Thank you Toto2020

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