Ablation or rate control drugs?: I read an... - AF Association

AF Association

22,180 members26,974 posts

Ablation or rate control drugs?

Slattery profile image

I read an article from Steve Ryan who is saying if you have Afib and you are on rate control drugs your heart is getting weaker and enlarging. He states we should all be looking at a better alternative such as Ablation. I have Afib with few symptoms and decided not to get an Ablation at this time. I would like to hear what you think.

33 Replies


Who is Steve Ryan? Interested to know where he is coming from,and what research he has utilised. The question is pertinent to me!

Slattery profile image
Slattery in reply to wilsond

Steve Ryan’s Website: A-fib.com, he has written a book called Beat Your Afib.

Following- If it’s true ( I will ask at my appointment tomorrow) that’s why I don’t want the drugs but ablations haven’t got me away from the drug

If you only have a few symptoms you probably have very few pills to take.

I do not know the man you speak of .

There is much talk of Ablations on this site. You could read those posts.

For some , Ablations work , there are different types of Ablations.

They did not work for me.

Steve Ryan’s PhD is in Educational Communication - he is like most of us an interested AF patient only.

Went through all this in the beginning, now 9 years ago. I rejected ablation outright and told cardiologist that I didn't want any bugger barbequing my heart. I'd go for rate control. That's it. Bisoprolol. End of. I have adjusted my life style, followed a sensible eating plan and only one AF event since April 2015. That's due to my sleeping on my left side.

Luludean profile image
Luludean in reply to carneuny

Well done you carneuny!!

BobD profile image

I will tell you what I tell everybody. ANY and ALL treatment for AF is only ever about improving quality of life. You choose. Do you own research and don't be influenced by anybody least of all me. lol If I were going to listen to anubody it would be a specialist in AF not another patient.

Hidden profile image
Hidden in reply to BobD

I agree

most doctors will advise ablation only if your quality of life is suffering--as Bob and others have said, it's a choice you need to make. I was offered ablation when diagnosed 6 years ago but my episodes are infrequent so don't have any treatment except anti-coagulation I realise this may not last so it's wait and see!!

Aqua_1 profile image
Aqua_1 in reply to rosyG

Please correct me if I'm wrong - my understanding is that ablation should be performed sooner rather than later as the condition can worsen and should you then decide to having the procedure there is less chance of it being successful?

icklebud99 profile image
icklebud99 in reply to Aqua_1

That's what I have read too.

secondtry profile image
secondtry in reply to icklebud99

This debate will run and run because most of the bases of a decision are individual and no reliable data on right or wrong outcomes of those decisions are available; this is because you will never know the alternative result eg. if you go for drugs and you get AF in 3 years, this cannot be deemed unsuccessful as an earlier ablation route may have caused complications and still require drugs and a second ablation.

So if you are lucky enough to have the option to choose, the key issue is it is not what is 'right or wrong' but what you 'prefer'. Simple then or...!

rosyG profile image
rosyG in reply to Aqua_1

That’s true if you have frequent AF because re modelling of the Atrium occurs and electrical pathways get established in different areas. However if you only have very infrequent AF this won’t be the case and the heart recovers in between episodes.

But some people are in permanent AF without even realising it. Heart rate normal etc. They often settle for that without ablation as dont like the risk of ablation

It’s also more complicated now as modern expertise means those with long standing AF have better chances of ablation success now. There are formulae that take into account all your individual health factors and give some idea of likely success - so very individual and choices need to be made with your doctor!!

dmac4646 profile image
dmac4646 in reply to Aqua_1

It should be an option after other treatments have been tried like losing weight ruling out triggers and medication - very rare to go straight to ablation.

Spot on, Bob D.

Perhaps the article you were reading was this one:


The crucial factors to consider are how frequent are your episodes and how long do they last? If you are getting frequent episodes that last considerable time such as three days in AF and three days in sinus, the probability is that you will go into PERSISTENT AF within a year, according to another article I read, which is what happened to me. Then the choice does not become a rate control drug or ablation but "live with it" or ablation.

I wish I had had a GP who would have sent me to an EP immediately upon diagnosis rather than keeping me on rate control for a year until I became persistent, plus a system that would do an ablation right away, rather than keeping me in persistent for months as my condition got worse and worse ( it takes one year in persistent to get to long-standing persistent AF. Then it's a whole different ballgame. ).

From personal experience, I would suggest anyone on rate control and left there, should really monitor oneself as well as get really informed of the consequences.

In terms of Steve Ryan, his website was a god-send. I strongly recommend his website and his book about beating AF.

rosyG profile image
rosyG in reply to cuore

Sorry you had GP who didn’t allow proper choices. It’s worth asking an EP what they think about ablation fir you if you are keen. Less likely to be a success now but still worth asking

The sooner an ablation is done the higher the success rate, well at least that’s what my EP told me. I had about five bouts of AF and one cardio version which worked for a short period. Had an ablation in July, no drugs or AF since.

I suggest you read the disclaimer at the bottom of the page. To sum up, this is not a medical website!!!

cuore profile image
cuore in reply to Buffafly

I respect your viewpoint, but I cannot be persuaded in your court. Disclaimers are necessary legal formalities.

Steve Ryan, a PhD in Communication, has never professed to be an MD. He is a well-informed patient advocate, author of "Beat Your Afib," which is recommended by world-class EPs, publisher of the website "A-fib.com, and counselor. His AF was "cured" in 1998 in Bordeaux, France by ablation. He brings to his website personal experience as well as a very strong desire to help fellow afibbers to find their cure.

Let me expound somewhat on his website:

- his website has a library that contains videos and animation

- his website contains resources and links for AF patients, overview of Af, directory of doctors and facilities, and an extensive bibliography of referenced articles used on his site.

- to date 99 stories of personal AF experiences are documented for one's perusal with Steve Ryan's editorial comments for insightful explanation

- He writes his own editorial pieces on current breakthroughs

- He was the only patient to ever present at the 2016 Multidisciplinary Arrhythmia Meeting in Zuric, Switzerland to over 200 + surgeons and EPs.

- He is available for consultation which includes his personal access to top rated EPs throughout the world.

- He has attended and reported on the annual January AF Symposium , now in its 24th year , for the last 15 years. From this symposium, he selects the latest technologies and advancements presented there and explains them in detail in layman's terms.

- HIs website is well-rounded and comprehensive for a newbie seeking AF information.

- He publishes for free a monthly newsletter delivered to your mailbox

His website would be an enlightenment to a paroxysmal afiber and imperative to a persistent one.

For me, he was a god-send as his website guided me through the trauma of persistent AF which my GP, by keeping me on rate control , let me become, and my cardiologist plus EP, through the demands of legislated social medicine, let me remain persistent for months immune to the waiting time leading me to long-standing persistent AF. It would be a tragedy for the patient world of AF if we were ever to lose this website.

Buffafly profile image
Buffafly in reply to cuore

I agree it is a very interesting and informative website, my point is that it is edited by an interested party and not simply a presentation of the latest official medical opinion as found on NHS or BHF websites. Your GP was certainly at fault and I am glad the information helped you get suitable treatment. I do get annoyed when someone who has made a choice based on a full medical assessment is upset by dramatised information, that's all. (I've read Slattery's previous posts).

Ablation does not work for everyone, it didn't for me it made me a darn sight worse, so now I have a pacemaker but still take rate controlled drugs.

Ablation worked for me, Got me off the hated brain fogging drugs. (so far...........!).

My first echo showed slightly enlarged atria when diagnosed. The second after approx 12 incidences in 20 months did not , but did show mild LVH. (I was on rate control during that time).

However an echo is not a precise science there is interpretation ( I am not medically trained but the words of my GP), plus at 58 years old she would have expected my heart not to be perfect anyway, so her advice was not to worry about it until someone trained says its bad! So did AF damage my heart?? I don't know but suspect it did not help.

As others have said, if you don't mind the drugs then do drugs, but if you don't want the side effects and are worried about progression then ,look at an ablation.

When I was deciding what to do my EP advised that he thought could stop the afib, and his view appeared to be that it would be beneficial (he knew i did not get on with the drugs). But it was up to me.

In the UK EPs don't need to look for work, so I believed him and I wanted off the drugs so it took me 30 seconds to decide to have the ablation.

Aqua_1 profile image
Aqua_1 in reply to KMRobbo

KMRobbo, were you asymptomatic when you were taking the drugs? I am yet i hate taking them as well hence why my preference would be to also move forward with an ablation.

KMRobbo profile image
KMRobbo in reply to Aqua_1

I was asymptomatic in afib, except the one time I my afib developed so that my rate control did not work and I spent over a week in high rate between 130 and 190 bpm. After that I was shattered. However I had no symptoms other than that.

But I had lots of side effects on some of the drugs: bisoprol 1.25mg, asleep in 40 mins after taking every pill, and for hours! I woke with pain in chest and arms, low heart rate, my hr limited to 117, enough only for a fast walk on the flat. Atenolol, not as bad but similar, very tired but could usually manage 5 or 6 hours awake, slightly better exercise tolerance, and no pain. Verapamil 120 mg mod release, very good, hardly any symptoms but all it did was prevent my hr risng to quickly in afib. By that time I learned that if I popped a 40mg fast acting verapamil or 2, and went for a run then after 7 or 10 mins my hr returned to nsr owing to the excercise and the extra pill ,which took about 4 hours to get into the system, kept me there. However after 20 months and 12 attacks, the running trick stopped working and the verapamil could not cope fast enough to keep my hr low, hence why I was in afib for 8 days. I was cardioverted by flecainide infusion in my local hospitals CCU. Then I was put on 2 x 50mg flecainide which I think I tolerated, but I was also put on 200mg ditiazem modified release as rate control which was better than the beta blockers but terrible. Breathlessness , tiredness, and brain fog, poor memory, poor exercise tolerance - max HR 137, but it was agony to keep it up there so I exercised less and put on weight. I actually think I was over prescribed on the drug , as I tried 120mg for a time and it was better, if not great, but, breakthrough afib,caused by me missing a flecainide one night, resulted the cardiologist to put me back to 200mg. I knew by this time I was having an ablation in a few months so stuck with the drugs. Post ablation when i came off all drugs, I stopped the diltiazem and still felt bad. I was worried that there was something else wrong, but four to six weeks after i stopped , the brain fog lifted, and my memory came back , i became much sharper again. I think the side effects got worse the longer I took the diltiazem, but as it was gradual it was not obvious(plus my brain was not too sharp!). It was strange as diltiazem only has a short half life as active, but the side effects were there such a long time! Extremely happy not to be on drugs now!

Aqua_1 profile image
Aqua_1 in reply to KMRobbo

Oh you have been through so much and I'm so pleased you are doing so well. Touch wood i haven't had too bad a ride since switching from Sotalol which only made me feel worse to a combination of Flecainide and Verapamil. I just want to get off the drugs altogether. Im still relatively young so i don't want to be on drugs for the next 30 or so years.

KMRobbo profile image
KMRobbo in reply to Aqua_1

No not really - I only put up with Bisoprolol for a week, and atenolol for 2 weeks - i could not function on those drugs. Verapamil was fine for 20 months, it only the diltiazem was 10 months that was a grim as i had to put up with it..

Buffafly profile image
Buffafly in reply to KMRobbo

For me it was the Propafenone+Diltiazem combo that was the killer - think Zombi balloon with bad constipation. I feel fine on 120 Diltiazem alone and now on 180 trial still feel good, but I can't really exercise even if I wanted to because of worn joints in leg. We all have to make informed decisions based on personal factors.

When you have persistent afib(drugs or not)your heart is getting damaged. Rate control just makes you safer and damage takes longer. You can live with afib, but I would suggest ablation.

I think the thing to remember is no 2 AF patients are exactly the same, different ages/comorbidities / personal details/lifestyles all need to be taken into account when we decide how we manage it.

So although it is useful to read different opinions, each person really needs to look at their own circumstances before making any decisions.

I have decided an ablation will be a last resort for me, a decision supported by my own GP but I appreciate others will come to a different conclusion.

I am complicated so not the best benchmark? I have had 3 Ablations and 9 Cardio Versions! Still on Bisoprolol 7.5mg reduced from 10mg due to PH drugs making BP drop down to silly levels. It has been decided that I will only be treated medically from now on as the extra risks of surgery or procedures is to high a risk. I also have a few allergies that do not help?

Be Well

Yes, I would also like to hear what others think. I take 25 mg of metropolol daily and have about 4 bouts of AFib a year. Tired cutting back to 1/2 tablet but found that my AFib episodes increased slightly so went back to 25mg. Hate to think my metropolol is gradually doing harm to my heart. With 4 to 5 bout per year I correct things with 200 mgs of flaccanide which does the trick overnight the next morning. Hope this isn't bad for the heart also/

You may also like...