One of the things the consultant said to me was that if you have repeated episodes of Afib, the heart becomes “remodelled”, ie the Afib pattern becomes normalised and v difficult to correct. Hence he wishes to intervene before this happens with an ablation. But how long does this remodelling process take, months or years? Anyone have any ideas? I’m asking because if possible I’d like to kick the ablation out into the long grass, ie delay it as long as possible.
Remodelling of the heart: One of the... - Atrial Fibrillati...
Remodelling of the heart
42 Replies
•
Maybe it is more meaningful to think in terms of so called “AF burden”, which is another way of saying the amount of time in AF.
A 2 hour episode every month for 5 years would be 120 hours of AF.
Two 12 hour episodes a week for a year would be 1,248 hours
I imagine there are several other factors involved but I think the second scenario might result in far greater remodelling. Of course this is just speculation on my part and I have no source to quote.
All I can say is that when I was first referred to a cardiologist for tachycardia I had an echocardiogram and my heart was structurally normal. Two years later after repeated SVT episodes and Atrial Flutter my echocardiogram was repeated and my left atrium size had increased to 4.1 cm putting it in the mild enlargement category for women. Since then I’ve also developed AF and had multiple episodes so I’m sure it’s still being damaged. I had an ablation 5 weeks ago but have a lot of inflammation so I’m waiting for that to settle down so we can see if it has been successful.
Hi Samazeuilh, I delayed for 5 years whilst my AF got progressively worse ie one attack once a month lasting a few hours, to eventually every week lasting 24 hours to 5 or 6 days.
I eventually had a cryoablation because my QoL was so crap. I have been AF free for 4 years now. Still get ectopics, but I have a life!
Only regret is why did I wait for so long! Get it sorted!!
I had AF for probably around 15 years or so before my ablation. As long as you're still paroxysmal and not persistent the chances of success are still good. I was trying to hang on as long as possible but in the end the AF got up to 80% and I had my ablation. I was glad I hung on as procedures had improved and my ablation was successful.
Ablation success will be much more likely at the beginning of the AF journey - AF is progressive. If you wait until atria is enlarged then ablation is much less likely to succeed.
It sounds to me as though wanting to delay is an emotional response which you are trying to justify. Not logical, but you must be happy with your decision and understand the potential consequences of that decision - either way,
AF = Uncertainty.
CDreamer, always like your way of thinking.
My AF episodes started over 15 years ago.Was occasionally come and go for short. No med. was taking . Symptoms were checked periodically by cardiologist
With the time episodes of PAF became more often and not mandatory ablation was offered or med. that was prescribed .
The reasons for PAF is nor clear.Sometimes, there is a few ablation should be done.And AF returned after.
I have settled for medication as PRN. I do not let AF episodes run. As soon as I FEEL the beginning of AF I am taking Bisoprolol, 2.5-5 mg.
If in 1/2 hour AF doesn't stop, I am taking Flecaidine 25 mg.
Of course, life style and food consumption under control.
But now I am concern what kind of test should be done to find out if I have any heart abnormalities, as an enlarge atria or dilated cardiomyopathy ,etc.?
Than might consider an ablation.
If your consultant is advising you to have an ablation why would you not? With this condition the ablation procedure will be your best chance of returning to a normal life with minimal risks to your health. I left it too long because I was reluctant/scared to have an ablation, I suffered the consequences of AF getting worse and when the ablation day came although I was scared I couldn't wait for it to happen. I wish I would have had the courage to step up 3 years ago but thankfully it all seems to have worked out in the end as I'm doing well now.
If your consultant says an ablation is the solution there's nobody on this forum better qualified than him/her so it's a case of taking their advise or taking a risk. I wish you all the best but avoiding what is recommended by the medical professionals will not be a better route for you in the long term for sure. Take care and best of luck.
• in reply todjbgatekeeper
You are right. I was not expecting to be referred so quickly, so there is an element of surprise. I will definitely go for the assessment and see what they have to say. If they say it’s urgent, I will, reluctantly, go along with that. It’s just that many ablations don’t work, so it’s offputting
djbgatekeeper• in reply to
Yes I know exactly what you mean, after several appointments with a cardiologist I went to see an electrophysiologist, he discussed my history and we both came to the conclusion that the best way forward was an ablation. He looked on his computer then spun round and said "how does next Friday suit you?" I nearly fell off my chair as I expected much more notice. I reluctantly said yes and on the 7th of September I had the procedure. It's a daunting prospect I know but at 75 - 25 in your favour it can be a life changing step. Best wishes to you 👍
I had undiagnosed AF for maybe 10 years and that caused my heart to enlarge so that I had Dilated Cardiomyopathy. Once the AF was being treated the heart returned to normal size with only mild heart failure. When I do have bouts of AF the heart begins to enlarge again. I have had 4 ablations and would have more if needed and advised. As others have said, why wait? It's not going to go away but will progress over time. Grab your chance whilst it's being offered is my own opinion.
BobDVolunteer
WHY?
There is no doubt whatsoever that AF begets AF. The more you have the more you will get. Surely early intervention to prevent further excesses is sensible? This is why EPs consider such early treatment beneficial.
I have known people (myslef included) shy away from ablation at first and as the old saying goes."when the pupil is ready the teacher will come." In my own case the doctor (who was not an EP ) explained all that was entailed and I declined so he just told me to let him know when I changed my mind as it would only get worse. Within three months I was begging him to refer me! That it took another six or eight months before I got to see the EP and worked my way through the system only confirmed how right he had been.
Here in UK where you do not pay for these things you will not be invited to have a £15,000 procedure unless the EP thinks it will help you. Leave it too long and the chances of success may well fall drastically.
I temper these comments with the obvious life style caveat. If you have reversable life style issues such as alcohol missuse, obesity (BMI greater than, 25) excess exercise , dietary issues etc these should be addressed as this has been shown to greatly improve AF burden and should be dealt with before considering ablation.
One of the problems with AF is that you can have episodes which you do not know about I.e. When you are asleep. And how long had you had a problem before it was recognised/ diagnosed?
I often wonder how many times over the years that periods of feeling "off" were, in fact, AF.
My advice? Have the ablation as soon as you can. Give it your best shot - do not risk living with regrets.
Yes. I might have had Afib for about 10 years before it was correctly diagnosed.By then it had become permanent and nobody was talking about ablation .I had not had any unpleasant episodes until one miserable such event sent me to the hospital.I never had another until 2016.It was horrible but only lasted about 1 hour. As a consequence,thus far, all appears reasonably well..i.e can walk pretty well, work in every way pretty well,brain and body and do not get breathless. So.......no 'attacks' may add up to slow deterioration of the quality of the heart condition and therefore quality of life.Just a guess.Soon there will be some further investigations so |I will have a better idea if i am right ,or not.
• in reply tojennydog
The thing is, at the moment I don’t feel “off” in the sense of breathless. The main issue is the anxiety associated with it. I am inclined to health anxiety, and at the moment every time I get an ectopic or flutter I worry that this will lead to a bout of Afib. I also feel anxious going to sleep, as most PAF episodes occur at that time. I could be having them whilst asleep without knowing . The consultant (and the GP) said there was no point in doing a holster test as it might not show Afib at night, when I am actually having it on otherniccasi Balance. But this seems to have things the wrong way round: surely if it’s known that I have episodes when falling asleep, they should monitor to see if these are happening regularly.
jennydog• in reply to
I had a monitor fitted for 7 days. It picked up a lengthy episode on the 4th night while I was asleep. I now take my daily 2.5 bisoprolol at night.
It is important to record a diary whilst wearing a monitor so that unrecognised AF can be identified.
Hi, I have a badly worn hip joint. 7 years ago I was told I would need a replacement sooner or later. Later has arrived as far as I am concerned but two musculoskeletal specialists and my physio have told me it is still not bad enough to warrant a referral 😭 You could do several hip ops for the price of an ablation so if you have been offered one I would assume there is a good reason. When an ablation was first mentioned to me (about 13 years after first diagnosis) I was told by my cardiologist to wait as long as possible 'because they'll get better at it' so at that time the impression was that patients were being used as guinea pigs to some extent but with the Star Wars equipment which I had used in December 2015 I think those days have passed.
Two ways to go, hide in a corner of get up and dance - wish I could!
I think about 2008 Richard Schilling told me that technology had topped out and no improvements were expected so all we have left is EPs getting better at it. True there have been one or two experimental procedures but after a while things go quiet again.
If it was war we could expect some magical changes, Just look at aviation from 1914 to 1918 and again 1939 to 1945, the sound barrier, vertical take off etc etc.
Yes, that is the general consensus...afib begets afib. I had two episodes, one in 2005 and the other in 2007 and as far as I know, no more. I began taking ARBs for high blood pressure and in some medical journals it is suggested that both ACE and ABRs tend to stop the afib circuitry from becoming established. The two afibs makes me eligible for blood thinners, but I am considering the AF burden and so far am declining them. That may change.
• in reply tosdalen
I wouldn’t have thought two lone episodes years ago would warrant an ablation or even much by way of medication. Were these very protracted episodes and hence of greater concern?
sdalen• in reply to
No. Both resolved by themselves within hours. I suspect menopause although "they" keep saying no. But there you go. I got breast cancer twice and the medication helped put on weight so am actively trying to get rid of that as obesity is not only a cause, but can cure and/or greatly reduce Afib episodes....trying to beat it to the draw...lol....breast cancers were early...so that was good.
I was diagnosed Oct 2o15.I had 12 attacks to July 17 which I could cope with by exercisec and minor drug intervention
After this my AF went unmanageable. Remodelling? I don t know but it sounds s like it.
I have had ablations this year and am off drugs, and so far AF, since. If your medics think ablaton I would get on with it. Not medically trained but this is my experience.
If my AF or flutter came back tommorrow morning in would hapily have a 3rd ablation tomorrow afternoon, preferably early.
I have been off drugs so e may and no AF since january
Another thing to consider is how problematic is your AF?
My AF is now permanent. By I have a 'variant" which is sometimes called 'Silent AF' or 'Lone AF') so other than the odd palpitation I have no symptoms and live my normal healthy life. I can give you more details of how it progressed to this stage if you would like -- let me know.
Having looked at drugs, ablations and having examined the data (less persuasive than you might think!) and discussed it with GP and cardiologists we've decided to do nothing at all. Most people find that (doing nothing) the hardest thing to do, but it can be the right course of action.
I hope you find the right way forward for yourself too.
Hi whiteface I have same as you a few failed cardioversions !! So they saying they might not do anything else ?? Except medication do you have to take it too ?
No I don't take any medication. My doctors (including a cardiologist) recommended against. Bear in mind that your blood is designed to clot when needed, and not to clot when it shouldn't. If you take an anticoagulant you stop your blood from clotting as easily and this has various (negative) consequences which should be weighed against any positive benefits.
In my case the situation was simple as the advice was don't take which I was very happy with. (See my other reply to this thread to 'oyster' for some more on this. Also you might want to take a look at my other posts)
I had one cardioaversion when I was 30 which worked (and was almost certainly uneccessary). I then started getting more regular bouts when I was 50. At first yearly, then every three months, then every month, then every week and finally (2 months ago and 10 years later -- I'm 60 now) permanent. I had found a way to revert them (exercise) and also found out that I didn't need to change my lifestyle much. Now, I still cycle around 10 miles almost every day and go all day hill walking too. I'm actually enjoying life more now that it is permanent. Identifying the triggers and trying to stop the next bout started to turn my life into a misery.
Hope this helps
Thank you !! It sure does I too am 60 still working 4 days full time and walk to work and back !! On my next hospital visit I think they may take me off the apixaban!! I feel quite concerned about that ?? Will really need to think about it !
Imagine this -- I'm at the top of a 3000ft mountain in Scotland on holiday when AF kicks in. What to do? Immediate problem the 15 mile walk down back to the car. Nothing else to do but go for it. So I warn my partner -- " I may die but if so I'll have died happy doing what I love with a person I value". Somewhat frightened we walk on and hey presto 6 hours later I'm fine.
But what next? Cancel the rest of the holiday? I carry on and midway through the next day the AF stops.
My point is that when you don't have a choice it is easy. When you do have a choice it is much harder.
And some choices are hard because defined obvious measurable risk (Stroke) is difficult to weigh against the unknowns. My cardiologist told me that the benefits of Warfarin were outweighed by its negatives -- it is just that I didn't bother finding out what the negatives are.
Here is the first website I found healthdiscoveries.net/warfa.... Here is the summary
"The serious long term effects of warfarin depend partly on your age. Here’s what researchers say are the long term side effects of warfarin:
Side effects of blood thinners and blood clot meds
Bleeding strokes, or brain strokes. (hemorrhagic strokes)
Calcium build-up in the arteries and narrowing of the aortic valve that goes from the heart and carries oxygen to the body. (aortic valve stenosis)
Alzheimers and dementia are higher in users of Coumadin long term. Especially if warfarin is used for heart irregularities, or AFIB.
Hope this helps
Thank you for your reply whiteface !!! I should read more I think ! I am always guided by what my consultant advises but will look into anticoagulants and there contraindications maybe they will take me off them ?? Until I am 65 but that’s will be a tough choice for me to Take !
• in reply towhiteface
Do you have in mind when, if ever, you are likely to accept anticoagulation?
whiteface• in reply to
No I don't know. I've got 5 years to decide because the predictive tool they use (I can't remember the name) won't recommend anticoagulants until I'm 65.
Is it critical to know that, in the past, a lot of people had AF and never knew it. Modern medical practice is now picking it up and it is my opinion that in many cases people are being treated when treatment is not only not needed, but also counter-productive.
I read the Framlingham study (on which the recommendation to take anticoagulants is based) ncbi.nlm.nih.gov/pubmed/406... and wasn't persuaded at all by the data. I read another report which is similar but less well known ncbi.nlm.nih.gov/pubmed/175.... BOTH actually point to a simple conclusion. AF doesn't kill it is the other things that are wrong with your heart that kill you. Do some searches on "lone AF' and 'Slient AF' if you are interested.
I then looked at stroke risk nhs.uk/news/neurology/risk-... and decided for myself that I was extremely low risk
I read the book " the haywire heart" too.
And finally I took stock of death choices and decided dying of a heart attack or stroke was preferable to cancer or infirm old age, or dementure etc.. (Of course living with a stroke is a different thing entirely).
I now accept I'm getting old and things are wearing out including my heart.
The above is my personal view and clearly NOT in line with most comments on this site or with the medical profession!
Take a look at my other posts if you are interested....
Hope this helps
• in reply towhiteface
Hi whiteface
Thanks for the links. Do you find the paper below at all persuasive?
academic.oup.com/eurheartj/...
whiteface• in reply to
Personally no (probably down to my philosophy/world view).
I read it -- thanks -- but I found it raised more questions than it answered.
I'm not an expert in reading this data so may have got this wrong -- but the first thing I saw was that half a million presented in hospital in Sweden with AF (how many don't present?). That is 5% of the total population or >15% of the over 55 bracket. So I found that extremely surprising... At that rate there would be 3.5 million people in the UK similarly afflicted -- and that doesn't sound right.
The second thing was in Table 1 where you will see that the group who developed dementia (26,210 people) had a higher CHA2DS2-VASc risk factor (4.2 vs 3.4 in the control). The authors seem to agree this "Patients who developed dementia were older and had more comorbidity than patients who did not develop dementia".
And later they state "Being a retrospective and non-randomized study, it cannot prove or disprove causal relationships".
Why do I take this (world) view? Well, I read some interesting and provocative books on data. One was called "The Drunkards Walk" and the other called "The Signal and the Noise" and now, despite having spent nearly 15 years in research (by the way I have a Doctorate in Biochemistry), I'm very cautious about research and what it apparently "proves".
Each to their own -- if you want to take OAC then please do.
Personally, I'm happy to live healthily (I started cycling every day almost 50 years ago and am still doing it). I still weigh the same and measure the same when I was 25 (that is 35 years ago). And as there is no incidence of dementure in my family, nor of stroke I'm personally very relaxed.
So, I'm no longer really very interested in statistical studies which include people with lifestyles diets etc. I know nothing about.
I take the view that all medication carries a risk of something (else) so I stay off it if I can. (It would be very interesting to see the studies from 50 years hence on the long term effects of warfarin for example.)
(And I'm religious so death isn't the end of the world).
A long answer to a short question....
• in reply towhiteface
Thank you for that detailed and helpful reply.
whiteface• in reply to
I've just been thinking some more about the paper you sent.
Here are some other things that came to mind (although the data is not there in raw so it is difficult to get to the bottom of it).
What I can see is that 26,210 people developed dementia of the group of 444,106. So 417,896 people DIDN'T get dementia. Doctors want to put everyone on anticoagulants -- so 417,106 people would be taking medication they don't need.
In addition the paper says you are 29% more likely to get dementia if you are NOT on anticoagulants. From which I calculated that 11,445 people on anticoagulants got dementia and 14,765 people got dementia who were not on anticoagulants. So you are going to change the outcome at the very most the difference between these two numbers -- 3,319 people. But the success rate is going to be low (it won't work for many of them ) let's say 10% (you can chose a different number if you like) so then you would save 300 people from dementia. So you unnecessarily medicate 417,106 people in order to save say 300.
That is what is happening time and again with modern medicine.
And that takes no account of any other solutions. For example a doctor friend of mine said dementia was much less likely for musicians as they used their hands for different purposes. So rather than warfarin, how about violin lessons?
It is all VERY complex.... there are lies, damned lies and statistics!
• in reply towhiteface
Agreed, not so impressive.
Individualised/personalised medicine always beats inferences from herd statistics.
whiteface• in reply to
And in reply to Edm174 I found this website healthdiscoveries.net/warfa... Here is the summary
"The serious long term effects of warfarin depend partly on your age. Here’s what researchers say are the long term side effects of warfarin: Side effects of blood thinners and blood clot meds
1) Bleeding strokes, or brain strokes. (hemorrhagic strokes)
2) Calcium build-up in the arteries and narrowing of the aortic valve that goes from the heart and carries oxygen to the body. (aortic valve stenosis)
3) Alzheimers and dementia are higher in users of Coumadin long term. Especially if warfarin is used for heart irregularities, or AFIB.
!!!
• in reply towhiteface
Without being able to access the full original papers rather than the abstracts, it is impossible to say why this information might have been discounted. Any website promoting a product is never going to present a balanced view. But thanks for the heads up.
whiteface• in reply to
You are right.
Separately, and for the record (this isn't really for you just want to get it off my chest) the only study that I see cited to justify a correlation between stroke and AF is the the Framlingham study.
In this study: -
1) There were 572 cases of stroke (And if I understand correctly 122 were not relevant but nevertheless the conclusions are based on the full 572 people.) It is questionable how much can be concluded from 450 people...
2) Of these 572, around 80% had hypertension, 30% coronary heart disease, and 15% heart failure. Depending on age, between 6.5% (50-59) and 30.7% (80-89) had AF. 84 in total had AF
3) Another paper (also based on the Framlingham data) cites 32 men and 11 women who had "Lone AF" (i.e. were free of these other conditions.) In my opinion you cannot conclude anything from a base of 43 people -- but conclusions were drawn!
4) Of these 43 (Quoting) "Atrial fibrillation cases, however, had significantly higher rates of pre-existing non-specific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms."
My take?
1) If you do have any of hypertension, coronary heart disease, heart failure and ECG abnormalities then I'd do something about it.
2) The first thing I'd do would be to live healthy. The second thing is to tell my kids because it seems that living healthily from youth is important. Apparently you can't undo the damage done to your heart later in life.
• in reply towhiteface
I am not on an anticoagulant either as my CHADS2 risk is 1. In a couple of years (when I reach 65) I will need to take it. However, when I spoke to a consultant last week he was dismissive of this, and said that CHADS2 is just a guideline and, in general, anyone with Afib should take an anticoagulant as the risk is about 1 in 80 per year of having a stroke. He now wants me to seriously consider taking one.
I had two fast AF episodes earlier this year which resulted in having cardio versions to correct. Last week my heart went into fast AF again and was prescribed Flecainide which has done the job and I am back in rhythm again without needing an op.
I don’t fancy the prospect of having an ablation and am very relieved at finding a drug that keeps my heart in rhythm.
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