Up until a couple weeks ago, my four afib episodes were ten years apart starting in my 30's. So I cardioverted and forgot about it. In the last two weeks I've had 8 episodes. Two episodes of afib, the first lasting an hour and the second lasting ten minutes. Five episodes of SVT each lasting under five minutes. And one episode of atrial flutter lasting under five minutes. All documented with my Kardia Mobile. I should also add (or let's say speculate) that it's possible I've had these under 5 minutes episodes in the past and just wasn't aware of them since I didn't have a Kardia Mobile until recently. I guess that's both the good and bad of today's technology!
Wondering if anyone has had similar and what approach they took. I'm not against ablation but I am inclined to try that last after various medication strategies in stages. My inclination is to start with taking nothing and then react to each episode with either dilitiazem (for rate) or Flecanide for rhythm if necessary. So far not necessary as they seem to go away by themselves. Hopefully the past two weeks are an anomaly and the events will slow down or abate for awhile as they have over the last 40 years. Next step might be dilitiazem and/or Metropolol daily. Next a daily anti-arrythmic like Flecanide. Last ablation. Does this make any sense or should I be on something now? Yes, I started on and will remain on Xerelto to keep myself safe. I am also seeing an EP soon but wanted to get forum input. Thanks. Jim
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What life style changes are you making? These can have a great impact on AF burden and often mean that treatments are much easier. The usual things are no alcohol, reduce over exercise. reduce stress. reduce reliance on meat and processed foods. BMI less than 25. All important, Many people with AF actually improve their life and expectancy in these ways. All and any treatment is only ever about improving quality of life after all so self help often helps the team treating you.
Since we are not medically trained here we can't comment on drugs by the way other than say well done over the anticoagulation.
Hi Bob, Thanks for your reply. I can check all the boxes you mention in the "good lifestyle" column. After looking at your other comment, I revised the heading of the post as it looked like I was substituting this forum for my EP, which I'm not. But I am interested, in general, what others are doing in similar circumstances and how things worked out. Or anything else that anyone wants to add.
Given all the above and with hindsight of how my AF developed over 5-7 year period and given that all treatments for AF are to improve QOL and are not yet proven to prolong life - then if you can cope with these episodes I think I would avoid drugs altogether - Very personal view.
I would consider ablation if episodes increased in frequency and/or you were very symptomatic.
We are all different, react differently and have differing considerations so treatment options and preferences are very personal and the risks:benefit ratio needs to be reviewed by you with your specialist.
Hi James, my own history is very similar to yours, and once they believed I had a rhythm problem they went down the route of medication, with awful results. I just felt even worse. I didn’t become permanently symptomatic until 2 years ago, but then it deteriorated rapidly, hence my only real option left was to ablate. Three ablations later (I had SVT and Afib), plus all the lifestyle changes mentioned in Bob’s post, I feel great and only take Apixiban.
Life is now good. I hope yours resolves soon.
The commonly accepted knowledge is that the longer you leave it, the more likely it is to become permament (as it did with me) and the longer you are in permanent Afib, the less likely you are to respond favourably to ablation.
Maggimunro, Glad your ablation worked out. Did you have an SVT ablation first or were all three ablations afib ablations? My understanding is that the SVT ablation is easier and less invasive.
Absolutely right Jim. My first was a short blast to the right atrium, knocking out a short extra pathway that was causing my SVT. It was done under sedation and was an immediate success.
The second two ablations were for the 70 or so excitable clusters of cells around the 4 pulmonary veins coming back into the left atrium and these were the little so and so’s that were firing off randomly causing my Afib. Hence the two subsequent, more complicated ablation under general anaesthetic.
I do sympathise had a similar run of problems a few years ago then several episodes together, was put on Sotalol, which produced awful side effects and rat poison, which I did not welcome but still persevere with
Until I could hardly walk and was so weary I ended up in hospital with a suspected tia ( as they could not in any way confirm this, and all symptoms ifitted with sotalol side effects I doubt it) AF had become more frequent by the so they put me on cardicor and booked me my first ablation, cardicor seemed to actually cause more AF and after the ablation I was reasonably ok untl I got a run of bugs, PIp flecanaide put me in hospital actually stopped my heart and off for number two ablation
Much stress and bugs, and horrible reaction to flu jab caused AF and a new te of flutter tried everythinh they could to stop it side effects were awful, but bottom line was they did not work had a cardioversion, another ablation( with a nasty complication) two doses awful of hospital sickness bugs ( second one was really, really dreadful) both caused af/flutter 150 bpm then back to normal the stuff I m taking whilst “settling down “ after the ablation is dire side effects like a winning bingo card -full house even the unusual ones!
I speak for myself, we are all different, but for me the medication makes things worse Warfarin is not brilliant but I will persevere with it obviously as I don t trust the new ones with my tendency to react todrugs
I am working very hard on the lifestyle stuff although the wretched beta blockers seem to sabotage a lot of my execise and weight loss goals but am convinced it is the only way forward
Hope your plan works for you but completely agree with your thoughts
I was having 4/5 episodes per week lasting 5/6 hours. My EP gave me option as first line of defence - meds route or ablation. I decided ablation as there is some evidence that the sooner it’s done, the more successful. I was on bisoprolol for rate for 6 months whilst on waiting list and felt awful. Had ablation in November 2013, came off meds same day but stayed on anticoagulants. Took 5 months for all irregular HBs to go away. No AF since😁.
Glad you are on the Xarelto! A PIP (pill in pocket) approach may be just the thing for you, however when you see your EP you may want to consider putting an ablation first on the list, rather than waiting . The latest research is pretty clear that ablations are more successful sooner than later. Why let your heart get settled in to the bad habit of AFib and then trying to correct it. As others have mentioned, lifestyle is key, so make sure you are eating heat healthy foods, getting good sleep, stress management, and eating real food that is heart healthy, avoiding processed junk. Good luck to you as you get this sorted out!
Hi Grandma, Thanks for the heads up on early ablation having better results. The only study I was able to find was from the Cleveland Clinic but those with non permanent afib (paroxysmal were excluded. In other words, the study showed that the early you ablated once in permanent afib the better the outcome. Are you aware of any studies comparing ablation results of those in non-permanent afib vs permanent? Right now I have paroxysmal afib.
Saw a new EP yesterday who actually took the time to sit down with me and address my concerns. A big difference from my last experience where the EP expressed a strong bias for ablation even before he took my entire history. Well, he really didn't take my history, his NP did, and he popped in at the end of the visit to close the deal!
So in a nutshell, the new EP thinks the step by step approach I outlined is reasonable. So today I'm off all meds and we shall see. I don't think he believes that will solve things but he was secure enouogh to acknowledge that doctors don't really have all the answers with afib so trying different approaches makes sense. He also feels since my episodes are very short (many under 5 minutes) that I'm reasonably safe at the current frequency even without thinners. Of course that could change should my situation change.
Should no meds not work, I would then probably go on a beta blocker, possibly in conjunction with dilitiazem. Should that not work, then probably another combination, including daily Flecanide after having a stress test to make sure there was no underlying heart condition. Should that not work, then of course ablation will be discussed.
I certainly understand why some would want to skip some of these steps but for me I'm more comfortable step by step, especially since in the past I've had long periods of remission.
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To start blood thinners or not? Response. 
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AF & Edoxaban 60 mg blood thinner
Blood thinners or not?
