Would ablation help me?

[Nybroc]

My first brush with AF was in early 2010. In late 2010 I had a heart attack (NSTEMI). In the next 18 months I had several bouts of AF. It would revert to a normal rhythm in hours rather than days. Then I had dose of flu which heralded a more persistent version of AF. It took a cardioversion to get me back in rhythm after subsequent bouts of AF. I had an internal cardioversion in march but only stayed in rhythm for 5 weeks.

I'm convinced the reason so many cardioversions don't work is because of the long delay in seeing the cardiologist and then waiting many more months for the cardioversion. Once it took me eleven months.

Although I have been in AFIB for 6 months the big difference is my symptoms are hugely reduced in comparison to previous episodes.

At my last meeting with my cardiologist I said if my symptoms remained so low I was happy to stick to my medication and not have any more procedures. I am now wondering if spoke too soon. Am I putting my future health at risk by not trying to get back in rhythm?

[jedimasterlincoln]

Ablation is not a cure, it's always been considered to be Ablation therapy. Just like Cardioversion is designed to stop the heart and get it beating into normal sinus, so Ablation is designed to remove some of the areas causing missed beats/extra beats and irregularities. Of course, with scar tissue and healing there is the potential for the AF to return albeit to a lesser intensity or less frequent.

If your symptoms aren't debilitating, or affecting quality of life, and you're content remaining on medications then I would say do you really need an ablation? After all there is no guarantee that having one will do anything noticeably beneficial for you.

[Hidden]

You might rephrase that, do I want to put my health at risk by having an ablation, when I have very few symptoms? What are those symptoms by the way?

The chances of ablation reversing persistent AF of long duration are much lower than with paroxysmal AF.

I imagine you are taking an anticoagulant, may I ask how old you are?

[Nybroc in reply to Hidden]

Thanks for your reply. I'm still working as a lecturer though I've decided to retire in February when I will be 66. Still enjoy the work but it's an hour and a quarter commute each way and that is getting to be a bit much.

I used to be on rivaroxaban but my G.P. practice swapped me over to edoxaban about two months ago. I also take beta blockers, statins, diuretics and losartan.

Previously when I have been in AFIB my symptoms have included tiredness, snoozing in my chair for an hour after work. Also limited energy, walking very slowly and needing to take a rest after walking up one flight of stairs. Now I feel much more energetic, I can go to the gym or swimming and do a reasonable amount of exercise. I am not and never was super fit but I can do almost as much as before AFIB. So to me this feels really healthy. I asked my cardiologist if it was anything to do with having an internal cardioversion and he said no. More likely to be weight loss but that was only 5kg.

I think everybody experiences AF differently but we can learn from what others have found.

You??

[Hidden in reply to Nybroc]

When I became persistent, I felt very unfit. I went back to the gym and resumed cardio, albeit at a lower intensity. I realised after building up slowly over 3 months that it was still possible to be “fit enough” for most things I need to do.

When I overdo it, I get uncomfortable ectopics the next day, which are improved with an extra bisoprolol. I’m still trying to work out whether it is worth continuing to take the bisoprolol regularly in view of the usual side effects.

I used to enjoy hill walking. While I could probably manage some less challenging walks, I am doubtful I will enjoy it, apart from the sense of achievement. I plan to find out.

[beardy_chris]

There are academic studies that suggest the life expectancy of patients with AF is not significantly different for a rhythm strategy (cardioversion, ablation, flecanaide, amiodarone, etc.) from a rate strategy (beta-, calcium channel-blockers, etc.).

My EP advised me that, because my symptoms from permanent AF were tolerable, I should not take the risks of having an ablation and that my life expectancy was the same or better with not following a rhythm strategy.

I don't know whether he was right or not but I'm following his advice which concurs with your decision.

[momist]

I took early retirement many years ago, and tried to find work for a couple of years after that without success. When I was then offered the work, I didn't want it! I'm so glad I retired when I did.

If you really want to keep working, why not see if you can change to part time or ad hoc work somewhere nearer to home?

I am no expert of permanent AF (mine is rare and paroxysmal). However, stress is definitely a factor with these heart problems, and should be managed as best you can.

[ochinee]

Here's a link to a 2023 study on long outcomes of ablation to give you a little more info.

I just had an ablation because I'm symptomatic and my quality of life has deteriorated. I don't like taking the meds either but that's just me. I probably wouldn't consider ablation if I had no symptoms and wasn't in persistent AFib.

pubmed.ncbi.nlm.nih.gov/367...