Ablation or medication

[gingerfurball]

Hi all 4 months ago i was in n out of AF and feeling really poorly so my cardiologist upped my medication and mentioned about me having another ablation but the heat one this time instead of the freeze one i had before, the medication has done its work and im feeling ok at the moment with just the odd blip, when i went back to see the cardiologist on friday he said that if i wanted to go ahead with the ablation he would be happy with that, so i wondered what everyones thoughts were on,, is it better to have another ablation or stay on the medication for however long they work for this time, im on 100mg flecanide twice a day and 7.5 bisoprolol a day

[Hidden]

I would have an ablation, but we are all different

[jennydog in reply to Hidden]

I agree. Those aren't minimal doses of medication and there's a likelihood of deterioration.

It was a good job that I avoided the freezing ablation in the first place as the cryo balloon is too small for the conjoined veins entering my heart. 25% of the population have this abnormality.

[Hidden]

Hi ginger, I can only share my personal experience. Diagnosed in early 2014 aged 69 with lone persistent AF which I had probably not had for long. Fairly benign lifestyle although I did lose a stone quite quickly mainly due to fear. Echocardiogram showed heart was in good shape apart from the AF. Responded well to a cardioversion which lasted just over a year without rhythm medication. Episodes of AF started but stopped using Flecainide PiP and stayed absent with the help of a Flecainide maintenance dose until June 16 when I had a Cryoablation. Stayed in NSR through to last October when episodes restarted but again controlled by PiP. I knew there was a chance that there would be a need for some touching up because there had been some difficulty in isolating one of the veins. Last Friday I had an RF ablation and am now in recovery mode.

I rarely drank alcohol, was not overweight, cholesterol at 3.7 and fortunately free from any other illness and was not enthusiastic about taking potent drugs for the rest of my life. I was lucky enough to have medical advice from consultants I totally trusted, plus the help and support from the folks here in the forum and at my local support group in Surrey. That said, they were not decisions made lightly, but I did what I believed was right for me and I have no regrets. Just be sure you do everything you can to make sure you are comfortable with your decision.......best wishes

[dmac4646]

Difficult one that level of medication is quite high (300mg daily max) ... but it’s a personal decision.

[hock217]

I'd go for ablation with heat. My preference is fix it and low dose Sotalol to prevent reoccurring. Discuss pros and cons with EP. Sending positive outcome thoughts your way.

[GordonS]

I am having similar thoughts as to whether to take up an imminent (next month or so) ablation. I have had 6 episodes since February where the AF has lasted over 5 hours or so and has generally reverted with Bisoprolol. I have not had any real problems in the last 2 months other than the occasional SVT and plenty of ectopics and have completed 2 x 100 mile bike rides. Currently medicated with 2.5mg Bisoprolol and Warfarin. I think I am moving towards having it done as I don't think it is going away and more likely to get worse. I had an ablation in 2010 which was a great success. Very individual decision and not easy to make, whatever you decide you will get lots of information and support from this forum. I don't think I could cope with 7.5mg bisoprol and I would definitely go for ablation if mine was that high, my resting HR is 48 on the 2.5 dose.

[KMRobbo]

You have quite a high drugs load compared to what i tolerated and that was not good. I cannot advise you what to do I am not medically qualified and do not know your situation well enough. In the end it is your decision. HOWEVER I can tell you my experience.

I had PAF since Sept 2015. My AF was fast (165 resting) but I was asymptomatic. I initially was lightly rate controlled with 120mg verapamil daily such was reduced to 60 mg. I also found that running in AF put me back to NSR after 7 to 10 minutes. So I did this for approximately 11 occasions in 20 months. Unfortunately after this time the running trick stopped working and I spent the best part of 8 days in high rate A Fib ( up to 190bpm). The AF had progressed and developed for the worse. I was cardioverted eventually by flecainide infusion in the CCU of my local hospital. I was put on a much more intrusive drugs regime of rhythm control flecainide 2 x 50mg daily and rate control of 200mg diltiazem. The side effect were progressively worse brain fog, poor memory, tiredness and exercise intolerance. It was horrible. At this point I started investigating an ablation which I had ( successfully so far) on the 29th January 2018. Unfortunately 9 days post PVI cryo ablation i developed atrial flutter which was very symptomatic, breathless with any movement and hr at 137 to 140 . I had to have a second ablation which I had in be right atria on the 26th February.

In hindsight I wish I had investigated an ablation much earlier as if I had had one i may have missed out a pretty horrible 9 months of my life. My understanding now is that " AF begets AF" so by having af makes you more likely to have it again. By dealing with the 11 episodes myself, which meant I did not discuss with doctors , so ablation did not get discussed. So what seemed like a good idea at the time actually caused me problems longer term.

All that said if I had been offered an ablation in 2016 I would probably have refused it! Again hindsight shows I would have been wrong EVEN though I had few symptoms as it went worse.

My EP advised 65 to 70% success rate with the PVI cryo ablation. So far I am in that happy band . I no longer take any meds from May15 this year and 4 weeks after stopping them I felt a lot better. Much sharper and less tired. I can exercise better again.

I do not know how long this happy state will last, days weeks months or years, but i am making hay while the sun shines, and if it returns I will have another ablation.

Best wishes with your decision.

[gingerfurball in reply to KMRobbo]

Hi KMRobbo because my heart rate is good i think im ok but in reality 70% of the time im feeling pretty rubbish im constantly tired, and sometimes feel so exhausted when ive been doing a lot it makes me feel sick and i feel i really need to sit down before i fall down, i keep get this awful feeling in my chest that i normally get just before i have a bad episode of AF, although it doesnt happen it makes me wonder if i wasnt on the dosage im on would i still be having all the problems, my worry is that because im 49 am i having too much done to my heart too soon if i go ahead with the ablation, but am i putting myself at more of a risk by staying on the meds, but reading what you've put makes me think i should go ahead with the ablation because i have a feeling if i stay on this dosage its not gonna do me any good in the long run, thankyou for your reply