Should I get an Ablation?

[Slattery]

I am a 70 year old women with no Afib symptoms, in good health other than Afib. I have had Afib for two years and do not take any medication. My doctor recommended that I get an Ablation, I would be on anticoagulants for 3 weeks and then off this medication if all went well. I don’t know what to do, I feel fine and worry that there could be complications with the Ablation. I need your advice in helping me make a decision.

[jeanjeannie50]

I've had three ablations and still have AF and in your situation with no symptoms I wouldn't advise that you have one. However, I do wonder why you're not taking an anticoagulant?

Jean

[Slattery in reply to jeanjeannie50]

In the US anticoagulants are given if you have other health problems other than Afib. Every case is different so this is not a clear answer to your question. My doctor does not see a reason to put me on meds at this time.

[Aprilbday]

Hi Slattery,

I know that you will get good advice here. I am sort of new and don’t know the answer, but just wanted to say hi.

I want to ask you if A-Fib runs in your family and do you notice any triggers that bring it on. Are you in the US or UK?

[Slattery in reply to Aprilbday]

Afib does not run in my family, I live in the US.

[Hidden]

Hello Slattery, this is a very difficult question to answer for a variety of different reasons. Ablation, like any other procedure carries a degree of risk but the general view is that with the latest equipment, the risks are low and the benefits can be considerable. If you think about it, forums generally attract bad news about things which go wrong. Not many people will resort to posting unless they have experienced difficulties or problems, so when you scan all the posts, it is comforting to know that posts from people saying they wished they had never had an ablation are rare. Consider the 1000’s of procedures which take place in a year in the UK alone, and you begin to draw conclusions that the majority of outcomes are likely to be positive.

However, any treatment should only be pursued to improve quality of life, but even that needs to take account of any changes which may occur over the passage of time. Every specialist that I have heard speak will say that an ablation is likely to be more successful if is carried out as soon as possible after diagnosis, but most also talk about how improvements to lifestyle can make significant improvements to AF.

So all in all, not an easy subject to give advice on, but if I were you, I would have a meaningful discussion with an EP to get an opinion based entirely on your own personal circumstances and then , maybe, you will be in a better position to decide what is going to be best for you. It is also surprising that you are not permanently prescribed anticoagulants assuming your CHADs score is probably 2 or more.

This should in no way influence you, but I am having my second ablation at the end of August and I have absolutely, no regrets.......good luck.

[Petrified]

Good post Flapjack! It's easy to forget that most people have a positive response to ablation. Very difficult to advise when someone is symptom free.

[IanMK]

If you have no symptoms then what would you expect to gain from an ablation? Most often they are performed to improve the quality of life when the symptoms are causing distress. Although most ablations are routine and trouble free they are not totally without risk. The success rate is around 80% (may need more than one attempt) and the condition may return. However, I would think that an anticoagulant is appropriate.

This is not advice, just my personal thoughts. I am not medically trained.

[Hidden]

Three months ago you were saying you have no symptoms with Afib and have a couple of episodes a month which last 24 hours or less - or a bit longer according to a later post. I'm much the same, though I'm well aware if I have AF. It doesn't hold me back much. I was offered an ablation (which would be number 4) 18 months ago but opted to see how things went. I'm much as I was then. My specialist has discharged me and says come back if you have any problems, so I am drifting along in a fairly happy way. Currently I've not had any AF for 42 days which is a long time for me. However it tends now to last for longer and I am not convinced that my level of fitness isn't diminishing slightly. It's a long time since I last had an echocardiogram.

So I am not much help to you, sitting on the fence, not taking anti arrhythmic medication on a daily basis, not having an ablation and wondering how wise I am being. I do take an anticoagulant and although I thought it was a very scary prospect and would prove to be a serious mistake or even a fatal one, five years on I've no concerns about it.

I do think I would be much worse than I am if I'd not gone down the ablation route and the second one made a very big difference as I was able to give up a large daily dose of flecainide.

[Bshersey]

If I was in your place, I would want to know that my heart rate, blood pressure and heart ejection function were all within a normal range while in constant afib. If they are, I might question my need to have one. If they are not, then I might be seriously thinking about a cardiac ablation. When I found out I had afib, my HR and BP were high and EF was low. Now, after ablation, they are all within normal range.

[doodle68]

Hi Slattery I was recently faced with a similar dilemma, I have P-AF, am aged 69 and was offered an ablation when visiting the clinic in May.

So I wrote down the 'for' and 'against' points to help me form a decision....

Against ablation = my P-AF is controlled, my quality of life good, I am tolerating the medication. An ablation will not prevent my having to take medication for the rest of my life (for blood pressure and anticoagulation). An ablation cannot cure my P-AF and at best may make me symptom free but it could produce side effects which make my quality of life worse. My ablation would be carried out in a hospital that has had very little experience of the procedure and if it needs to be repeated I will have to travel 100 miles + away.

For Ablation =I have P-AF which can be progressive, an Ablation may prevent that progression and make me symptom free for a long time . As someone with P-AF I stand a good chance of a successful ablation more so than if I wait and my condition progresses to persistant/permanant.

My answer was no to an ablation at the moment, I will review my decision in a years time.

Meanwhile, I am doing my best to get as fit as possible by losing weight /taking regular daily exercise (a brisk walk totalling an hour a day) /avoiding stress/eating a healthy diet.

This may lower my AF burden and prevent its progression (as suggested by some research) and if I do need an ablation my body will be in good shape to make it successful.

I may have made the wrong decision but as Dr Gupta says it is all about quality not the quantity of life.

I should add I am a 'bird in the hand ' kind of person who values and is happy to settle for the quality of life I have now rather than striving for something better, I don't even do the lottery preferring to spend the £1 on something I can enjoy now.

Slattery you must decide for yourself what is best for you and your particular circumstances, maybe do what I did and write down the pluses and minuses to help you decide :-).

[Hidden in reply to doodle68]

I feel exactly the same, Im 65, life is good, a fib at this time only visits briefly 2-3 x year. Im happy to take anticoagulant and have discussed this with my horse, who promises to be nice to the old girl😂

[doodle68 in reply to Hidden]

....who better to ask Hoski it is hard to know what to do for the best when faced with such a decision...

[Hidden in reply to doodle68]

A crystal ball would make the decision easier, lol. I think most importantly is that we are comfortable with our decision. Plus, it is not necessarily a final answer, but at this time, a fib is not a quality of life issue. Now, my cardiologist and I differ re me taking daily flecainide vs pill in pocket. Jury still out on that disagreement, but flec and I get along ok so I dont physically have an issue with it, I just dont want to take it daily. My husband hates it when I disagree with the almighty doc, but Im sure Im not the first nor last opinionated old nurse this doc has had to deal with, lol.

[Hidden in reply to Hidden]

Keep it up. We don't want to be the last of a dying breed. CON's (crotchety old nurses.)

[Bagrat in reply to Hidden]

Well me and my pals some whom I'd nursed with for years, are all very bossy and opinionated and it seems to serve us well.

[Hidden in reply to Hidden]

Doggies and cats are excellent therapists too. They are such good listeners, don't interrupt, and give us their undivided attention. I believe, for me, often I know the answer to my question. I just need someone to listen while I hear myself think out loud. After this 'quiet therapy'I usually have the answer I need.`🐱 irina

[Hidden in reply to doodle68]

Hi doodle, reference the lottery (which I don’t do either) I remember someone once telling me that £1 is a small price to pay for a dream!...😀

[Hidden in reply to doodle68]

I agree with the 'bird in the hand' philosophy. Who knows what's in the bush?

[foxglove1]

i feel the same as some of the posts here.

I am PAF on no medication other than Apixoban and right now my fib does not give me any problems that i cannot manage. My concern is that I may come out of the procedure worse than when I went in.

My EP has talked about an ablation but has agreed to put me on the "watch and wait' list at my request. I have said that if my afib starts to increase and becomes intolerable with the episodes lasting longer then I would let him know and look to be on the list for an ablation.

Its a difficult decision and one that only you can make. These are my thoughts however.

All the best and would be interested to know what you decide and how you get on

[Hidden in reply to foxglove1]

My mother was not the usual A Fibber. She had a CABG following a heart attack at age 70. Sometime later she got A Fib , diagnosed around age 80. She was asymptomatic so they just put her on warfarin for anticoagulation. At age 95, we took her off warfarin due to high fall risk. She died at age 97. Her heart was in continuous a fib but she lived a perky old lady life and didnt have any heart failure that required treatment. Ironically, she had a massive stroke which is what ended her 97 years of pretty good health.

[Tantaanna in reply to Hidden]

So she had the stroke when taken off the warfarin? She was on warfarin for 17 years?

Just curious thanks

[Hidden in reply to Tantaanna]

She was on warfarin from around age 80 and we took her off around age 95, she had the stroke at 97

[BJShaf]

From what I understand from my EPcardio is that AF long term leads to heart failure. The sooner they can correct it the better because when it becomes long term much harder to treat. I also only had a little shortness of breath and that was it. Went in for my normal 6 month check up and the doc decided to do an EKG and there it was. We were both shocked. Are you seeing a cardiologist? Also electrophysologist cardiologist are the ones that specialize in heart rate rhythms. My understanding there are 2 things that need to be treated. The rate of your heart and the rhythm of your heart. They first try to shock the heart to get you back into normal sinus rhythm. They also try meds to help get you in normal rhythm, but many people do not do well with them. Sometimes it slows the heart rate down way to low and then they take them off. I was also told in the old days they would treat with pacemakers. Now that is something they would not do unless nothing else was working. Oh yes they also want you on blood thinners and most put you on for the rest of your life to prevent strokes. AF is totally different for everyone and the key is to get a great EP cardiologist to work with you.

[doodle68]

Hi BjShaf you say....[Quote=''From what I understand from my EPcardio is that AF long term leads to heart failure.'']

My understanding is that AF 'can' lead to heart failure but it is not inevitable. If you are able to eliminate some of the *factors that are thought to contribute to AF you stand a chance of having a good quality of life and not having heart failure.

*Factors as in comorbidities eg high blood pressure sleep apnea etc also making lifestyle changes.

[Hidden in reply to doodle68]

That's my story: in my 8th year of a-fib; no signs of heart failure, massive side effects with rate and rhythm drugs early on. Have a pacemaker, a successful AV node ablation, and a Watchman device. Take no cardiac meds including no anticoagulants. Am stable, feel well, and can go for several days without thinking about my a-fib. For me this is good Quality of Life. irina

[opal11uk]

Hi Slattery, my personal advice after reading your post is no, don't go through this procedure if you don't have to, whilst some have good results others don't so as far as I am concerned I would stay away from all procedures, all medications etc., until there is a need for them. I suffered from PAF for many years and was on medication including Warfarin, had an ablation which only made me worse and now wear a pacemaker as a consequence, I am74.

[Hidden in reply to opal11uk]

Hi Slattery. I agree with opal. My story above reinforces how much different we all are when it comes to a-fib treatment. If I felt good, and happy with my current quality of life I would not have any unnecessary treatment at this time. Even with my current level of care if something else were recommended that I didn't feel I needed I would stick with what I have as long as it is still working well for me. Yes, current thinking is early ablation may likely be beneficial but for me the key word is likely. From your post you seem comfortable and not in any distress. It's always a hard decision when doctors recommend further treatment Take your time deciding, get another opinion if it gives you peace of mind, think about how comfortable you feel with your current quality of life, and go with your gut feeling. If it ain't broke don't fix it. Just my opinion. Take care. irina

[giada in reply to opal11uk]

I agree with you Opal

[Mal7896]

I had Paroxysmal AF for over 2 years with no symptoms, but as happens frequently, it progressed to persistent AF. In a period of 6 months my LA went from mildly dilated to severely dilated, and I was heading for HF without treatment. Symptoms of chest tightness and extreme fatigue started. I opted for an ablation which I had successfully 3 weeks ago. I wish I had decided to to this earlier. Just make sure you get an experienced EP with many successful procedures under his belt.

[Staffsgirl]

Can’t advise, but find all the posts. Interesting. Wonder why you’re taking no meds?

I have PAF, discovered when under anaesthetic for fracture repair. Have had no symptoms, but my age, 69, and gender, make meds advisable on CHADS score. I really hate taking meds, but on the advice of GP take low dose beta blocker and an anticoagulant. I guess your CHADS score suggests medication? Are you advised meds?

Decisions like this are so difficult.

[Jamjarjan]

I am a 78 yr old female and had an ablation nearly 3 months ago. I was in a similar situation as you with little or no symptoms. I was a bit dubious about having the procedure but was persuaded that it was in my interests as AF does tend to get more frequent as time passes. I have had one episode since which didn’t inconvenience me. I must say that I have been feeling a bit tired and breathless since the ablation but feel I am getting a bit more energy now. Sometimes I wonder if I did the right thing by going ahead with it. It is a major procedure and not to be taken lightly. No one has suggested that I stop taking blood thinners which I would like to do, I still haven’t been given a date for the 3 month check up so will bring the matter up when (and if) I see my consultant. Hope this helps you in making your decision.

[Hidden in reply to Jamjarjan]

Hello Jamjarjan (love that name). I’m not medically trained but would urge you to think carefully before trying to stop taking an anticoagulant. If you are not familiar with the CHADsVAsc score, can I suggest you either google it or check it out on the AF Association webpage. Because of your age and being female, your score will at least be 2, if not more. Most EP’s do not encourage patients to come off anticoagulants because the general opinion is that the risk of stroke remains after an ablation. Also, an ablation is not necessarily a cure and AF can return and if it does and you are not aware, the risk of stroke becomes very real.

Sorry if this is not what you want to hear, but hopefully it will encourage you to check it out for yourself.

[Jamjarjan in reply to Hidden]

Thank you Fapjack for your advice, I was going to ask about stopping the apixaban before I took the leap into the unknown! I didn’t realise my age and other factors would need to be taken into account. The thing is, 8 months ago I didn’t know I had a problem and apart from feeling a bit tired occasionally I thought I was fit for my age. To be diagnosed with Atrial Flutter was a shock and I assume the ablation would return me to normal, on reading the posts on this forum is making me realise it is not quite as simple as I thought! I will look at the information you suggested. Thank you again for your input.🤔

[Hidden in reply to Jamjarjan]

T’is me again, we have all been there and most of us know and understand that it takes a while to come to terms with all the unknown issues which surround arrhythmias. The good news is that Atrial Flutter is the easier arrhythmia to treat by ablation (that nice Mr Blair was diagnosed with Flutter and he had a very successful ablation) so to all intents and purposes, there is every chance you will return to “normal” apart maybe, from taking Apixaban (your in good company there too....😉)

[Hidden in reply to Hidden]

Very solid anticoagulant advice. Thanks, Flapjack. We can't undo a stroke. irina

[Janith]

No. If l were you, no way would l have this surgery. Why?

[Jane722]

I had the ablation and all went well. However, the meds caused me more problems so I am scheduled for Watchman or Amulet procedure next week. The amulet is not yet fda approved, and this is a study. The best part of the amulet is getting off the blood thinner right away.

[Hidden in reply to Jane722]

Hi Jane. J had a Watchman device fitted this past January. Very happy to let go of the anticoagulants. Will take the last 10 Plavix before the end of July (per Watchman protocol in the US). I really hated the warfarin I took for several years. Would have the procedure again. irina

[seasider18 in reply to Jane722]

The Amplatzer amulet was approved by the FDA in 2016.

However I'm not sure what the difference is between patients with patent foramen ovale (PFO) and lAA left atrial appendage.

fda.gov/newsevents/newsroom...

[Jane722]

I had my ablation early on with afib after reading about the greater success early on. So far so good.

[Bagrat]

I am fortunate to be well controlled on meds and would be inclined to watch and wait. The decision has to be yours and the responses you feel to our replies may guide you to what you really want to do. I feel that many strides are being made in cardiac medicine and in a few years ablation in it's present form may be "old hat". At 74 the strides may not be big enough to make a difference to me though!!

[sdalen]

I had two afibs, one 10 years ago and one 12 years ago, very symptomatic in that I felt them. None since. Just did a stress test, nothing. I am 68 now. Doc wanted me on an anticoagulant but I am hesitant. I did have a month and a half of pac's on a constant basis and I think it was due to steroid eyedrops. They put me on Xeralto because of my history and about 30 days later had a rectal bleed. It stopped on its own. I have both piles and diverticulosis, so either could have been responsible. Wanted me back on Xeralto but apixaban seems better but much more expensive. So, undecided. I told doctor a decade ago, if I have a third afib will go for ablation because afib can and does beget afibs....but not always apparently. I am crediting my candesarten for keeping me ok as the ACE and ARB for high blood pressure can help prevent them.

[sdalen]

In short, leave well enough alone until you feel uncomfortable and/or have constant afibs because they do stress the heart.

[Slattery]

Thank you all for your help. your experience with

Afib, gives me a lot to think about, your advice is very helpful

[giada]

I would leave that one alone. If it's not broke, don't fix it.

[Brizzy50000]

My Quality of Life was becoming abysmal with AF so had an ablation hey ho! things are great now, but if you are happy with QoL and your OK with your condition why bother, just my opinion of course.

[GordonS]

Have you come to a decision? I am going through the same thoughts re whether to have ablation or not. My Q O L is good at the moment (just completed 100 mile bike ride), I seem to tolerate the meds (Bisoprolol and Warfarin) ok and I am not aware of any AFib attack in the last couple of months. I had 7 which lasted more than 5hr in the previous 4 months and many more short lived episodes of palpitations. I am on the list and expect a call up in the next month or so. I am leaning towards ablation as the last time I had one 7 yrs ago with the same EP it was a success.

[Sueleen13]

Hi, I had PAF for many years and I was offered an ablation, however I felt it was a bit macabre and almost like a Guinea pig. I saw a few EPs and they all offered me the ablation, none of which I felt I was able to go ahead. I was on Sotalol with low dose aspirin but the Sotalol did not stop my episodes, nothing seemed to stop them I just used to live with them. Finally I was offered a Cryoblation by an EP who made me feel so confident that I went ahead. it was the best decision I have ever made. My worry for you is that it could get to the stage where you are unable to have an ablation. I didn’t realise that this is not always offered . I’m so glad I didn’t put it off any longer than I already had.