Who should get an Ablation

[Slattery]

When should you request an Ablation. I am in good health, other than being diagnosed with Afib two years ago. I have very few symptoms when in Afib, lt do not bother me. I have noticed a lot of people are getting an Ablation, should I be thinking about this procedure? My doctor does not see a reason for Ablation, Should I question his decision?

[Hidden]

I will be interested inthe answers also. I have had a fib little over 2 yr also and no ablation but EP mentioned it last visit. What Ive been told is that it is most successful early in the disease. My fear is the few comments from people who say their a fib got worse after ablation.

[ncernaa]

If it doesn't affect you much, I would hold off on having it done. Instead try to find natural supplements to help you keep it under control. Of course, other factors include, age, activity level, etc.

Since I am 37 years old, and up until recently very fit and active, I chose to have the procedure done. The palpitations were interfering with my life.

[secondtry]

I would spend some time first looking at the different reasons why you may have got it rather than how to fix it - functional medicine. I don't think a delay of a year before you have an ablation will change things from the very brief info you gave us and you just may not need one. This suggested homework has the added side effect of improving your wellbeing generally. Start by mining the valuable information on this Forum. Good luck.

[CDreamer]

I would agree with the previous 2 comments - mine are in hindsight and after about 15 years of PAF and 2 ablations and yes, the first ablation caused me problems and made my AF & symptoms much worse, but the second, a few months later improved things dramatically and I had no AF for nearly 3 years. But there were complications and the sedation and the drugs and the procedure all exacerbated an underlying condition which is far more incapacitating. So now I have very mixed feelings as you can imagine! And the AF returned, although it is not nearly as symptomatic.

I think it very much different strokes for different folks.

If you are under 45, fit and want to exercise hard and symptomatic then I think it is very worth while.

If you are over 65, have Lone PAF and not symptomatic with no other heart problems then perhaps not.

It’s that bit in the middle which has a few more queries?

I was talking to my EP recently and they were saying that up until now western medicine has focused on interventions, often expensive and all of which come with risk of quite serious side effects. It also quantifiable benefits for the whole population but which is often less quantifiable for the individual.

The risk to benefit assessment for the individual can be a bit of gamble as the variables are unquantifiable - but the overall statistics seem quite good. If you are symptomatic it is a much easier question to answer as you may expect an improvement in your QOL and the intervention is for your QOL as I don’t believe there is any proven benefit for prolonging life - as far as I am aware but others may know more.

I think we are seeing a move toward Functional Medicine ideas which I would totally endorse but I can’t see it being mainstream until docotors are allowed to do extensive testing without question of cost, they are able to spend time with patient - a long time - 10-30 minutes appointments ain’t going to do it. And people’s expectations of being ‘cured’ without making drastic changes to their lifestyles changes.

Some individuals are already doing this privately but for the vast majority ????? It is expensive.

Very personal, difficult choice for you. I do hope thinking through the pros and cons here has been helpful to your process.

Best wishes CD,

[BobD Volunteer]

ALL and ANY treatment for atrial fibrillation is only ever about improving quality of life (QOL) as cure is not a word that applies here.

If your QOL is not affected by your condition why would you enter into a procedure which is not entirely without risk? I say this as a great fan of ablation but then I was always highly symptomatic and badly affected by my events and often laid so low as to be unable to function properly. It has been said that "when the pupil is ready the teacher will come" and I would say that unless you are crying out for the procedure it is best left to those more in need. So long as your heart rate is properly controlled and that you are anticoagulated if CHADSVASC decrees such then all is as it should be.

[MarkS]

I would hold off a bit. Ablation techniques are improving all the time. The success rate only drops when you go from paroxysmal to persistent/permanent AF. In the meantime, as pointed out above, try to find what might be promoting the inflammation underlying the AF. Are there any lifestyle factors that could be causing this? It's worth reading some of the articles by John Mandrola.

[Hidden in reply to MarkS]

I love Dr John Mandrola's writings, and agree with his philosophy

[doodle68]

My P-AF is being contained by medication with fewer long episodes and horrible symptoms and more shorter episodes with symptoms that don't bother me too much now I have learned to 'embrace them' and not to let them make me anxious.

I think maybe recommended changes in lifestyle have contributed to my overall heart health and the improvement in my AF. I have lost weight/given up alcohol/ eat a good diet/ take more exercise/don't allow myself to become stressed.

I was listening to an item on the radio this morning about some new thinking on inflammation which is part of the bodies natural immune response but can also cause damage in some circumstances and may even be responsible for a degree of depression we feel when we are ill or in pain.

I eat lots of anti inflammatory foods including nuts and was reading yesterday about the positive effect Nuts may have on AF..

thecardiologyadvisor.com/ar...

Anti inflammatory foods

health.harvard.edu/staying-...

For me this is the route I will be taking, I won't be having an ablation (not that it is likely to be offered in my area except in extreme circumstances or when medication fails ) unless things become so bad I have no option. Instead I will continue to maintain a positive attitude and help myself.

[Hidden in reply to doodle68]

My first EP appointment 2 yr ago, he spoke mostly about lifestyle changes. He said if I would follow them, my a fib might go away but would definitely be less aggressive. Ive done most of what you have mentioned and my a fib is less frequent and not as violent. Ive slacked off on the anti-inflammatory eating so need to get backon track. It has helped my arthritis also

[Aprilbday in reply to Hidden]

Hi Hoski

Your posting was an inspiration to me because I figured it was doomed to be on-going. It is uplifting to think that the A-Fib could calm down with exercise and diet. Thanks

[Hidden in reply to Aprilbday]

I mostly quit processed foods, gave up my too frequent runs thru fast food and traded diet pepsi for water. I dont drink any alcohol. Basically trying to stick to 2/3 of my diet fruits/ veggies, eat a handful of nuts daily. Ive only lost 35 of the 70 lb Im over weight as I have trouble behaving every day. So, it is spring, time for a fresh start!

[Aprilbday in reply to Hidden]

I have started to include more fruits and vegs for me too. I am overweight and have long term anxiety. My cholesterol is good and the doctor says my heart is good. Not sure what that means since I have A-Fib.

Spring is a favorite season as is Fall.

I was going to go to my campsite in Virginia today but got about 2 miles out and realized I was too much into fatigue. When does my strength return?! Drink de-cafe coffee now-no sodas.

[Hidden in reply to Aprilbday]

I was working full time as an RN when I was first diagnosed almost 2 1/2 yr ago. The meds really slowed me down, I had to go part time. 4 mo later I finally saw EP and he stopped daily meds and put me on as needed meds (pip= pill in pocket) that I only took when in a fib. As I got stronger and exercised more, within a year I had dropped 35 lb and felt great. Im now 65 and retired. The longest Ive gone between episodes was 11 mo, have had 4 or 5 in 2 1/2 yr, they last 2-4 hours usually. Last one went 12 hr so they put me on daily meds for now. Im torn re ablation or no ablation. My goal is to get back on track, drop the weight and see how the a fib likes the new me.

[Aprilbday in reply to Hidden]

Did he also stop the Pradaxa?

And I think A-Fib will behave on the new you 🤗

[Hidden in reply to Aprilbday]

I was not on an anticoagulant until

I turned 65. Then they left it up to me as I have no other risk factors. Im on xarelto but I was on fence post about that as we ride our horses and I sure dont want to fall. I bought a sexy pink helmet.

[Aprilbday in reply to Hidden]

Pink helmet!! Love it!!!

[Aprilbday in reply to doodle68]

Doodle

May I ask what meds you are on for A-Fib? How are they working? I am fairly new on here. I am on Dilacor, Lisinopril and Pradaxa. Pretty tired much of the time. Just put a chair in the kitchen so I can make healthy meals. I buy as many cut up vegetables as possible because I am clumsy and want to avoid accidentally cutting myself. I am 63. A-Fib makes me uneasy about life.

[doodle68 in reply to Aprilbday]

Hi April I take the anticoagulant Apixaban and the beta blocker Nebivolol, nothing else at this stage. I have taken them for a year.

I am 69 and now realise I have had P-AF for many years maybe 20 without realising my 'funny episodes 'were potentially serious because they only happened occasionally. I only took things seriously when occasional became frequent and severe.

I have lost over a stone in weight (16lb) slowly over a year and managed to maintain the weight loss through the winter. I need to lose a bit more weight to reach my target BMI of 25 and should do that through the summer.

There is quite a bit of research indicating that by losing weight to achieve a good BMI/eating a good diet/regular exercise/reducing stress /getting lots of sleep it may be possible to slow down the progression of P-AF. At the very least by doing these things you are giving your body the best possible chance to cope with AF.

I do get very tired at times but try hard to maintain a level of stamina with daily long walks and gardening. I know when I feel very tired I must rest and not 'push it'.

I grow some of my own vegetables, they are lovely straight from the ground .

I am hoping to steer clear of ablations in the hope some better treatment becomes available.

[cat55]

Hi, I suppose the thing about AF is that one cap doesn't fit all. I had my first episode of AF in 2001, I was 46. Over the years I have had very few episodes, no more than 12, in that respect I am lucky. In one of my appointments I asked the cardiologist about ablation. ( he had a great interest in arrythmias) we had a very long conversation about this, about three quarters of an hour!! and I decided to not go down the ablation route, quality of life being talked about, plus I am very procedure anxious, I have a pill in pocket medication, I take Apixaban. For me the weird thing is the nature of the episodes has changed, initially fast AF 160 +, now much slower but feel the irregular beat much more. Sometimes get odd fluttery feelings not quite like ectopics but who knows. So I will continue with things as they are for the time being and if things change will look first at how I tolerate medication and if quality of life badly affected then consider ablation. It was good though to be able to talk everything over and reach a decision.

Best wishes Kath.

[foxglove1]

Hello Slattery

I am in similar position.

I have PAF having a bout approximately every three or 4 months.

When I am in Afib, always at night, on average it lasts about 4 hours and apart from feeling a bit wiped out the next day it does not affect my life too much. I walk several miles a day, can still drink my favourite full strength coffee each morning and red wine socially, if i wish to.

I realise this is probably "at the moment" and my EP at my last appointment suggested thinking about an ablation, but I am not keen to go through a procedure that may make me come out worse than when I went in and having to go on other mediations. Right now I am only on Apixoban and hope to keep it that way.

My EP agreed that I could "manage" my afib and we would discuss at my next appt in June.

So in answer to your question, if it were me, and you are fit and well, I would take your doctor's advice. Is your doctor an EP?

all the best

[Slattery in reply to foxglove1]

I really appreciate everyone’s comments, it really helped me with my decision, not to get a Ablation at this time. Hopefully never if I take care of my health.

[foxglove1 in reply to Slattery]

Hi again

Iam so pleased hear this as it is my way of thinking absolutely - at the moment.

All the best

[foxglove1]

Hi again Slattery

I did not see the other the replies to your questions, when I sent you my response, but have read them now and very pleased to see most agree with the "if it aint broke dont fix it"

[cuore]

Yes!

[Dawfor]

Hi Slattery. I’m mulling this over too. My paroxysmal AF started to worsen towards the end of last year despite taking flecainide. As I was getting 4-5hour long episodes that were very symptomatic I decided to have the ablation I was recommended but wanted it in the summer so I could recuperate when the sun was shining!

Since then,for some reason I cannot fathom my AF has almost disappeared with very short,infrequent episodes. I have even managed to stop the flecanide so I have cancelled the ablation which I was very anxious about having anyway. The Arrythmia nurse advised it is unlikely to have gone away but also said I had to think about the best time for me to have an ablation,pointing out that I am fit and well with a structurally normal heart and this will probably change over time and thus could affect the outcome of the procedure. It was very helpful to think of it like that and to know it is an option should my symptoms recur to the extent I had them before when,despite my concerns I would definitely have it done.

[UScore]

I had 3 episodes of AF over 9 months, saw an EP and got put on the waiting list for an ablation. I had another 3 episodes whilst waiting. My AF stuck around for 10-12 hours without medication, was about 3-4 hours if I took Flecainide. Each episode felt weird and unpleasant, but not really painful or overtly debilitating.

I'm mega glad I've had the ablation. It was easy and almost painfree, and I felt fine within hours of the procedure. It's too early to say if it worked, but even if it hasn't the whole thing was such a non-event I haven't lost anything if it hasn't. And if it has worked then I'll not be inconvenienced by it again.

So I'm not medically trained, and this is just one anecdote rather than meaningful data, but I think ablations are brilliant and everyone should have them. Even if they haven't got AF!