Thinking of getting an Ablation

[Slattery]

I saw my Cardiologist EP today. He thinks I should get an Ablation, he feels I have a 85% chance of stopping Afib. I have 2 Afib incidents each month lasting 24 to 48 hours. I am concerned with Afib progression over time. The doctor has done over 2000 Ablation at Swedish Hospital in Seattle WA. I would like to hear your thoughts.

[Hidden]

Difficult to know how to respond without more context.

Is your AF burden increasing? How symptomatic are your episodes? Have you made all the usual lifestyle changes recommended?

Why has your EP recommended ablation? Did you decide to start anticoagulation?

[Slattery in reply to Hidden]

My systems are an upset stomach and diarrhea. I live a healthy lifestyle, I am on anticoagulants. My doctor thinks there is no reason to live with these systems and an Ablation can stop the Afib

[CDreamer in reply to Slattery]

So what are your concerns? Only you can make this decision as everyone will react very differently.

Why not follow the threads of people who were about to have ablations and those who have recently had them. You can learn a lot of how variable the experience and the outcomes can be.

My only comment is - what is the alternative? For me it was living with drugs which made me very ill or with very symptomatic AF which put my life on hold. Just remember that many of us have had to have more than 1 ablation and the vast majority have had positive outcomes, even though it may not ‘cure’ your AF.

[Hidden in reply to Slattery]

Are you saying that your AF gives you GI symptoms? Could it be the other way round? Vagal AF often presents this way.

[secondtry in reply to Slattery]

My take on AF is that for most people it is caused by a number of factors accumulating. I have vagally mediated AF so had to remove stress from my life and sort out my gastro issues; also have taken other lifestyle action. I was offered an ablation with 70% success predicted but was concerned over complications so turned it down. I use my decision as a driver to push me into taking lifestyle improvements I would never otherwise have undergone. At 65 yo, 5 years down the line on just Flecainide, my QOL is very good but I accept AF may come back at some point - hopefully the ablation procedures or alternative interventions will be better then!

[Coco51 in reply to secondtry]

Do you take Flecainide without a beta blocker? I am interested because my EP has said I shouldn't take Flecainide alone. But I have low heart rate and am not keen on the effects of bisoprolol.

[secondtry in reply to Coco51]

Hi Janet, yes I do take Flec alone and have checked with my cardio twice if that is appropriate. Most medics advise taking a BB or (I think) CB as an insurance policy. I have HR 55 or lower and BP lowish 110/60 no comorbidities and it was thought a BB would make me feel too tired/unwell. So far so good.

[Coco51 in reply to secondtry]

Interesting. I will mention this next time I see the EP.

[BobD Volunteer]

If you have exhausted all life style changes such as reducing stress. no alcohol, less meat and more plant based food in your diet and a BMI of less than 25 then ablation may work for you. I am a great fan having had three in the last fifteen years but frecent research ha shown that taking the above steps often removes the ned for ablation.

There is no cure for AF and all treatment is only about improving quality of life (QOL) so do everything possible first would be my advice. Here in UK doctors are not paid by how much work they do and are moving to this advice.

[Slattery in reply to BobD]

Bob, why are you a big fan of Ablation?

[BobD Volunteer in reply to Slattery]

Stopped my AF for more than ten years. Simples.

[Dawsonmackay]

The most recent research in the United States states (1) that ablation procedures are more effective than medication. And (2) Anyone in paroxysmal Afib (that's you) should have an ablation before it evolves to persistent Afib (that's me). Ablation for paroxysmal Afib has a 25% higher success rate than persistent Afib. Here in the US, ablation procedures, angiograms, Watchman devices, pacemakers etc etc have made ablations very routine and the risks incredibly low like 5% or less. BobD says consider exhausting "all life style changes such as reducing stress. no alcohol, less meat and more plant based food in your diet and a BMI of less than 25," may help with your success of ablation. I believe that this applies more to persons who have persistent Afib. Do not hesitate like I did and wait until you are in persistent Afib to have an ablation. Get it done now. I have had three.

[Hidden in reply to Dawsonmackay]

Interesting reply. However, I think that the research shows that lifestyle *may* resolve the problem for *some* people whether they have AF or PAF. Or it may at least reduce the burden of the AF/PAF. And even after ablation it is desirable to make/maintain lifestyle changes since the condition can return-requiring further ablation- and may be associated with other heart problems. When you say that there is a 5% risk, that refers to the overall risk of complications. That is not, imo, “incredibly low” [its 1 in 20] and needs to be broken into the constituent risks- some of these are quite minor and “fixable”; others, such as stroke, are not. You are correct when you say that current practice favours early intervention with PAF.

[Dawsonmackay in reply to Hidden]

I believe if you read my post again, I stated clearly that I was talking only about Afib and not PAF. I still stand firm that the risks are 5% for cardiac ablation for Afib.

[Slattery in reply to Dawsonmackay]

Where can I see the research?

[Dawsonmackay in reply to Slattery]

Talk to my EP.

[Slattery]

Thank you all the good advise. I have a lot to study and think about.

[Beta44]

I put up with years of slowly progressing AF before I finally opted for an ablation. It changed my life, back to being a normal person. If ever AF returns I will be asking for a second ablation.

Peter

[Hidden]

I too was given a figure of 85% by St Bartholomew’s Hospital, London, and have been proposed for an ablation. I have PAF roughly 1 or 2 times every 2 months with episodes lasting from around 3 hours upwards. I thought this was not too bad, but was told by the consultant that it was “still too often” and informed of the risk of progression and of the PAF going persistent/permanent. Eventually, too, medication will fail in the long term for a majority of people.

There is no easy answer to the question of whether to have an ablation or not. Issues to consider imo include the consideration that there is undeniably a non-trivial risk involved of death or, more likely, complications ranging from the fixable to the dire. At the very least it will be psychologically stressful for most people.

The basic problem is that one has to weigh present satisfaction/dissatisfaction against future risk. If symptoms are presently not too bad then there is a natural tendency to want to defer the procedure when it would be more rational to have it done immediately.

I doubt I have said anything here which you are not aware of already. If you do get any information on this procedure, particularly on whether it is reasonable to defer it for a while, alternatives etc. please post it here.

[Morzine]

I’m eeek 11 after my ablation, so far so good.....all I can say is that the fretting beforehand was much more worse than goung doing it.....for me, mine AF wasn’t a problem once my tablets calmed it down....but it was that cloud hanging over me of when will the next one come......and it was getting rid of that cloud that was my motive......if it comes back I’d have another without a blink of an eye......but we all are different aren’t we......I was 65 and PAF....cardio said it was a good thing to have so I took his word for it......I’m sure you’ve lots to read and will weigh it up.....

Sue

[Sarah57]

Totally agree with Beta44

Having an ablation totally changed the quality of my life and made me realise how awful I had been feeling..just really surviving day to day with family,work and life generally. I waited far too long but only had it offered to me after nearly twenty years.! They are much more aware of improving quality of life now which is great for us AFers

[Haymaker42]

I had mine done 10 weeks ago. I would not hesitate to have it done again. It has giving me my quality of life back. Hope that helps

[AIW58]

I had some reservations mainly because I thought I'd feel awful afterwards based on some of the experiences I read here. I had mine done 10 days ago. Very happy so far but am staying mentally prepared for a setback.

My QoL was fine beforehand as no AF since starting the flecainide last year, I had no risk factors (normal BMI, low/normal BP etc etc) that needed to be sorted and I wanted a longer term 'fix' then staying on meds. I don't believe the NHS would offer ablation if it wasn't worth it. My EP said for lone AF such as mine the success rate was good (80%). He also put the risks into context for me (it's from a national database so includes many 1000s of cases and different co morbidities of patients). If you have concerns about about the risks talk it over with your team so they can explain what the figures mean.

It's your decision but if cardiologist recommends it and you're having such frequent AF I'd go for it.

Good luck

[Coco51]

After 10 years of occasional AF, mine became persistent 24/7, and very tiring. I have had 2 ablations and now have occasional AF, but the heartrate is slower and the AF stops after a couple of hours. So not cured but better. I feel if I'd had an ablation sooner it would have been even more successful as persistent AF is harder to treat. I may be offered a third ablation. If so I will go for it. Good luck with a difficult decision.