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AF Association
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AF ablation risks and concerns

Hi all,

I'm new to this forum and have found a lot of reassuring posts and comments on here - so thank you to everyone who's contributed!

My situation: I'm a 43-year male, non-smoker, not overweight, CHADSVASC=0, generally good health... recently diagnosed with paroxysmal AF and a 'more regular tachycardia'. This is symptomatic and has been kicking around for some years but not so extreme that I haven't been able to ignore it.

Since I decided to do something about it this it's all moved quite quickly (as I'm lucky enough to have private healthcare through work). After initial diagnosis I spent 4 weeks on flecainide and bisoprolol and although this seemed to calm things down the AF didn't stop entirely.

My consultant suggested that PVI would be the appropriate next step and I'm scheduled for the ablation at Cromwell Hospital mid-Jan.

My problem is that no matter how much I try to rationalise it I can't shake the worst case scenario. I know this is a 'minor procedure' (and my 72-year old mother recently had a catheter ablation for SVT, making it seem easy!) and that it's normal to be cautious but I have a 4-year old son who needs me and can't stop thinking what it might mean for him. The worry is by no means debilitating but it is on my mind *a lot*.

Any thoughts or advice on how I can cope with this and emotionally prepare for the procedure would be appreciated!

Thanks

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I've been in the same position as you, Ive had paroxysmal AF since my early 30's and now 54 years young I had my first ablation on 7th September this year. All I will say to you is the fear of the procedure is completely natural, I was scared stiff and if it wasn't for the symptoms of my AF being more scary I would have probably ducked the ablation. That being said, now I have been through the process and I am feeling the benefits I would have a second one in preference to having a tooth out. The procedure was uncomfortable as it was done under sedation and not GA but it was over fairly quick and done by an excellent team of professionals who made me feel at ease... In short you have a fear of the unknown and once you have had the ablation All of that will change and you will be glad you went ahead ... Have a look at my profile of it helps as I have documented my experiences.. Take care and stay calm, all will be well.

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Thanks djb - this helped.

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You don't seem to be in the right place for a PVI in 3 weeks time.

Consider deferring it if your AF burden is low and your symptoms are manageable. How much discussion has there been around lifestyle changes as an initial approach to management? Remember that EPs like to do procedures and in your case have a financial incentive.

Others will answer the questions you have asked.

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I have to admit that I'm inclined to agree with oyster here. Have a look at lifestyle changes first and don't rush into this .

PS I don't call having multiple burns made to heart tissue a minor procedure but I suppose it's all relative

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I agree with Yatsura & Oyster. My AF was picked up a company medical earlier this year after I turned up stressed and knackered and put through a treadmill ECG test. Luckily the AF tripped in and it was finally diagnosed after a few A&E visits over the years only for it to have cleared by the time I was seen. My cardiologist strongly advised that lifestyle changes come first then medication and ablation if those 2 things haven’t worked. So I’d say talk to your cardiologist again and ask why they recommend ablation at such an early stage. Good luck

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I would agree with the above comments to try other routes firstand then think about an ablation. Although I was older it was by no means minor. My first ablation was 6 hours under GA and lasted six months, my second 7 hours under GA and took me many months to recover from. However having said that I felt so well for 18 months it was worth it. It’s a case of deciding how much the AF is affecting your daily life and weighing up the benefits. I have been offered another ablation as I now have paroxysmal AF but don’t feel badly enough affected yet to go through another ablation. Good luck whatever you decide.

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Thanks for all the responses. Not exactly the reassurance I was hoping for but appreciated nonetheless! To clarify my journey/situation a bit more:

Yes, I discussed lifestyle with both cardiologists I've seen and beyond tinkering around the edges there's not really a great deal of scope for improvement. Weight, diet, exercise, blood pressure, cholesterol, caffeine, smoking - all under control. I drink a little more than I should but I'd already pretty much halved this through the year and if anything the AF has got worse/more frequent! I've also had 24 blood pressure monitoring and tests for sleep apnoea.

Yes, this has all moved rather quickly, but that feels like a product of the private healthcare, rather than any rush to decision. I certainly wasn't encouraged to have the ablation before checking if rhythm/rate control medication would solve the problem (I had a 7 day ECG Zio patch to check). It didn't, so the ablation was recommended.

No, my symptoms aren't desperate - writing this about a week since anything noticeable it's hard to remember what the fuss is all about! - but I know when it's at its worst it's horrible. No real chest pains, breathlessness or anything like that, but real discomfort and a sense of dread that my heart isn't working as it should. I'd like to be rid of it now and in case it gets worse.

Believe me, I'm not taking the prospect of an ablation lightly, but pragmatically it does seem like a reasonable solution.

Thanks again to those who have taken the time to post here!

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I, too, was very fearful before my ablation 3 weeks ago but would now have another if needed. I’m older (69) so my situation is different and I was thinking more of my young grandkids. I unsuccessfully tried lifestyle modifications for three years after diagnosis but, as they say, Afib begets Afib, and I developed shortness of breath with no exercise tolerance, frequent tachycardia with HR’s to 225 that had too many triggers to possibly avoid, and mild left atrium enlargement. So it got worse and was damaging my heart. In retrospect, it would have been healthier to have the ablation done shortly after diagnosis, but I wasn’t mentally ready then. Everyone’s path is different and you’ll know when you’re ready. In my case, it is such a blessing to feel well and be Afib free for 3 weeks, I would willingly have another, altho I would undoubtedly be fearful once again. All the best to you as you figure it out.

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Thanks for the well-considered reply. Hope you're well.

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Hi

In a similar position to you had it diagnosed last year offered an ablation but put it on hold. I'm 53 but had it undiagnosed since at least 2014. Currently on flecainde,apixaban and bisoprolol which controls it most of the time, no high BP, cholesterol normal, tested for apnea which was negative. My lifestyle apart from work stress is pretty healthy. Gonna get myself tested for magnesium deficiency and c reactive protein and if they are normal I will reconsider it if it gets worse. I would check the track record of where you may get it done as I suspect some centres are more successful and have less complications than others.

All the best its a decision I am wrestling with as well.

Andy

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Thanks Andy - appreciate the reply.

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Look up as much as you can on the AFA website to help you come to a decision.

Only you know how you feel.

I went the private route and saw a cardiologist who put me on medication and I’m doing fine.

My friend was also seen privately, but by an EP who did an immediate ablation & she too is fine.

We are both women in our early - mid 60’s

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Thanks Archie. Thought I'd read 'everything' I needed to on this but you prompted me to take another look and I found some helpful stuff.

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To respectfully offer my personal experience. I'm 42 and a week ago had an ablation last week through private insurance, both PVI and a typical flutter prevention line. To my knowledge complications are nowadays very rare and there is evidence that AF is best treated early as it may prevent paroxysmal AF becoming persistent and the success rates are better whilst things are paroxysmal or early persistent. It is also extremely rare that it will make the AF worse (my ep said he had never heard of this happening). Nevertheless I obsessively read a ton of journal papers and textbooks as well as the patient oriented guides and this forum to try and reassure myself that I was doing the right thing. They are killing heart cells after all 🙂. To give a bit more background, after some early persistence this summer, with Amiodarone my AF had become paroxysmal on exercise only. I did have some bad dietary habits and extremely rare episodes of binge drinking between months of little to no alcohol (it's fun to get drunk!) but I quickly fixed those and that didnt have an effect on the exercise issues.

How do I feel now that I'm in the other side? I'm glad I did it. I'm still scared it may have made matters worse despite the assurance of my EP since I had a 30 seconds episode of palpitations the other day. But I'm being silly - I'm very early in the recovery period where such things can occur and many would rightly laugh at me being worried over such a short and mild episode 🙂. And if it has worked I can back to some hobbies I really enjoy, hopefully for a long time (unfortunately these procedures are often not permanent fixes) . The procedure itself took 1.5 hours and recovery for me have been painless (privately they heavily preferred doing it under GA and the anesthetist was extremely skillful) and until this little episode I had actually been feeling fantastic. At the moment I'm a little hypervigilant for every little twinge. Hopefully that will be temporary.

So personally I say go for it. From my research, the procedure is extremely low risk and has a good chance of putting back the day when the AF may become more debilitating. Though some can live with AF controlled through drug therapy practically asymptomatically, for me the pre-ablation episodes were extremely debilitating, particularly the persistent ones. I will not hesitate to have another catheter ablation as early as possible if necessary and feasible. However, my situation is a bit different from yours. Though like you my Chads VASC is zero, due to an underlying heart condition the only antiarrhythmic I can take is Amiodarone which has a chance of causing other permanent issues, the probability increasing over time. So I was particularly keen to take the chance of getting off that drug. I'm also single with no children so not as much to consider there. With medical stuff there's always going to be some residual risk, though I feel with the common catheter ablation procedures like PVI it's now on the level of risking your life when you get into a car.

Whatever you decide, the very best of luck to you.

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Great to read such a well constructed post, even if I do disagree with your penultimate sentence. 🙂

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Thanks for your post. Really appreciate the reply.

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Hi velgor. Welcome to a great afib forum. There are so many people here who have had ablations and are doing well. I am one.

I hope many see your post and take the time to provide reassurance with their positive experiences.

Sometimes hearing about other patients' successful outcomes is more reassuring and calming that many doctors saying 'everything will be fine.'

Maybe browsing the forum for posters' ablation experiences will begin to help while waiting for posts.

Good luck. Mine was 2 years ago with a pacemaker also received. I'm on no meds and doing fine. I believe you will too.

One of our regular posters (BobD) said (I'm paraphrasing) "You won't die from a- fib. You only think you will in the beginning."

(Sorry Bob if I got it wrong.)

Take care. irina (age 74 US)

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Thanks Irina - appreciate the support!

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You're welcome.

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