Offered Ablation

[Hambo444]

Hello. I had an episode of AF when I was 25 and been pretty good over the last 20 years. I had an episode recently that stayed (persistent af) for a couple of months but had a cardioversion a few weeks ago and is now back in NSR and symptoms are ok (still on medicine) at the moment. However recent appt at specialist and their recommendation is still to have an ablation (6-9 months waiting). I realise things can change at any moment but just wondering if worth the hassle if symptoms arnt too bad..or should I just expect that af will come back for sure sometime in the future - perhaps today - who knows? So I should have it.

[Hidden]

Hi Hambo444

Hard to answer without knowing whether there are changes to your lifestyle you could make which would reduce your likelihood of getting more AF.

Was there an obvious trigger for your recent episode?

[Hambo444 in reply to Hidden]

Not that I am aware..got my suspicion that it may have been from exercising (too vigerous for my fitness level), but weight normal..no diabetes..no high blood pressure..only moderate alcohol (although none in last 3 months)..realise there prob is no answer just felt like venting

[Hidden in reply to Hambo444]

There are some risk factors we can’t modify like family history of AF which gives us the predisposition to AF. You have mentioned important reversible factors to which one should add a stressful lifestyle, anxiety and chronic over exercise. You will already have had an echocardiogram to rule out structural heart disease.

What explanation were you given for your episode 20 years ago? How many episodes of AF have you had down the years?

If you have no reversible risk factors and a 2 month episode of AF requiring cardioversion, I can see why your EP is recommending ablation, on the grounds this is likely to be progressive, whatever your level of symptoms at the moment.

[Hambo444 in reply to Hidden]

Thank you for your thoughts. No family history. Yes had echo and was fine.

One or two episodes early on straight after but then been pretty good since. Always had some ectopic beats (jumps around when exercising normally at the beginning) and then 1 or 2 little runs of AF during the day but kicks back in fairly soon (e.g. seconds) and still get that now but no real issues. Persistent AF I felt terrible until I got on max bisoprolol and then had good and bad days until cardioversion.

I think if I knew for sure it would come back (which I know is extremely likely) I would want to get it done..but just got me by surprise as didnt think they would consider as in NSR. Thought would wait until reverts back.

[BobD Volunteer]

AF is almost always a progressive condition so if you have no reversable life style triggers and you are being offered an ablation I think you should consider it carefully. It is more likely to be successful if done before the AF has taken hold and become more frequent. With a 6 to 9 month waiting list a lot can happen in that time and if you wait until it does then you will still have a 6 to 9 month wait (at least) . My opinion only of course and you must make your own mind up. Just don't look back and regret it whatever you choose.

[Hambo444 in reply to BobD]

Thanks BobD

[djbgatekeeper]

Hi Hambo, I am 54 now, I had AF from my early 30's but like you only infrequently so not really a concern. Over the last 3 year's the symptoms just got progressively worse and then at the start of this year I was having runs of AF daily. I had an ablation 5 weeks ago and so far so good.

As mentioned by others the choice is yours but from my experience I wish I would have gone for it earlier instead of going through 3 years of hassle. Good luck with whatever you do.

[AIW58]

Hi

My experience similar to djbgatekeeper. Had episode related to high thyroxine level in my 30s which settled spontaneously. 5-6 years ago it started again (thyroxine normal) I'd get a couple of episodes, months apart lasting about 4hours. But since last Dec been getting episodes every month. Still

only last 2-4 hours. I take Mg increased my fluid intake cut back on caffeine and zero alcohol. Normal to low BP normal BMI. (age 58 female)

Saw a cardiologist earlier this year who recommended Flecainide daily and put on waiting list for an ablation. I was apprehensive about having an ablation after all the things I’d read on this forum. However there was a recent thread that made me more positive about having it. I hate wondering every day will I get an episode it’s a constant nagging worry. I’m pretty sure your AF will return. I ignored my once or twice a year episodes and now it’s every month. Although hoping Flec will control it until I go for the ablation. I started the Flecainide 2weeks ago and feel fine on it and feel more relaxed that I won’t get an episode of AF. If the ablation works it would be great to get rid of the AF worry and although the Flecainide is OK I’d prefer not to been on tablets everyday.

Is there an arrhythmia nurse you could talk to to help you decide? I’d def go on the WL as you can change your mind any time.

Cheers

[momist]

Every case is different, as I expect you know. I'm 69 this week, and have so far had only three episodes of AF in the last 18 months. Mine last about 8 - 10 hours, and the last two I just went to bed and rested, then fell asleep until they stopped in the small hours of the next morning. I was offered an ablation after only the second episode, with a 12 month waiting list. Then last week I was suddenly offered a rush appointment for pre-op with a new EP, and I turned it down. I don't feel ready for an ablation when I've not had a bout since March, and they don't intrude too much on my lifestyle.

There are risks both ways. Many reports of ablations which didn't work first time, several repeat operations until success, and then many also which seem to be immediately successful. Always though, there is an impact on your life during the recovery period. You will always need the anti-coagulation, and possibly a beta blocker or something to stop any further developments.

The decision is yours, but faced with possibly another 40 - 50 years or more ahead of you, I'd be inclined to try the ablation. They say, as you know, that it only gets worse.

[Hidden]

I was told by my GP that there is some evidence that there is evidence that an early ablation can improve Afib outcomes. See the paper below. Extracted:

“Progression from a paroxysmal to a persistent or permanent form of AF occurs in 10% to 20% of the general AF population at 1 year. In AF patients treated with catheter ablation, the percentage of progression is substantially and significantly lower and not affected by the duration of follow-up. Given the association of persistent AF with increased morbidity and mortality, research is required to determine whether delaying progression of AF by catheter ablation reduces morbidity and mortality. Prevention of long-term progression of AF may be a clinically relevant outcome after AF ablation.”

From: electrophysiology.onlinejac...

[MS444]

I had one event aged 40 and then at 44. But PAF not continuous AF. By age 60 I had had over 100 PAF episodes. I had an ablation at age 60. It fixed it.

[Hambo444 in reply to MS444]

Thanks. Glad all went well.

[MS444]

I notice someone advised you that you would need beta blockers and anti coagulants for the rest of your life if you had an ablation. This is not true. It would only be required if your medical professionals had reasons for this in your particular case.

[Hambo444 in reply to MS444]

Thanks. DR did say he was hopeful of being able to reduce medicine after ablation. I guess I will learn more about his as leading up to procedure and agter.

[wilsond]

Recent research by Birmingham University said that anti coagulation was necessary for life even after an ablation,but I dont think betablockers was mentioned.It was published in the summer this year.