Hi all, I’m a 23 year old very active male who serves as a full time firefighter/EMT. I was recently offficially diagnosed with paraxomimal Afib. I usually have 1-3 episodes a month ranging from a few minutes to 6 hours one time. The doctor said I could either do the ablation or the medication of anti-arrythmics. The only issue with the ablation is that I would be required to be on blood thinners for a few weeks before and three months after the ablation and blood thinners are a big no-no in the fire service as well as having Afib. I could be disqualified. I have been working for a fire district for 2.5 years and have a good relationship with my admin but we’re a small district and I’m afraid they’ll freak out if I tell them I need medical leave and or be put on light duty for nearly 4 months. I have about a month of PTO saved up just in case of stuff like this. I joined this community cause I’m very scared of losing the profession I love And need insight. Do I bite the bullet and get the ablation done now and hopefully my district supports me? Or do I go on drugs for a while and postpone the ablation? Thank you
23 year old recently diagnosed. - Atrial Fibrillati...
23 year old recently diagnosed.
Whether you need any treatment would perhaps depend on how symptomatic you are. This is usually linked to how fast your heart rate is. Having said that, AF is a progressive condition and at your age ablation would often be seen as a better option than years of taking potentially toxic medication. Lifestyle changes can help reduce AF burden. Alcohol is an issue for some.
Thank you for replying! All my episodes happen when I’m laying down and often after eating. I have always converted myself, usually by standing up and walking around. I do live a pretty active lifestyle, I lift and run/mountain bike about 5 days a week and 2/5 of those days we do workout circuits outside in our turnouts and on SCBA. Im honestly terrified that my career in the fire service is gonna be over before it even started. I’ve always dreamed of being the captain/ chief who’s been on for 32 years but at this point I’m not confident I’ll be able to work long enough to earn my pension. So maybe I should just go straight for the ablation?
I am not a medically trained person but I also have PAF and will possibly have to have ablation in the future.
It's not an easy condition to cope with and reading how very fit you must be to do the job you do I admire the way you are trying to get this sorted.
You have age and fitness on your side and as has already been mentioned the condition can affect the heart more as you age.
I am sure if you had a "heart to heart" your colleagues etc would understand how passionate you are in your chosen career and want to support you
If you read through previous postings on this site you will be able to see the many sucessful outcomes and I'm sure you will get a lot of feedback in the next few days.
We so need our firemen - you do such amazing work saving lives.
Do let us know how you get on
Thank you and will do, yeah I’m feeling largely heartbroken and terrified at the moment, thank you for replying.
Don’t tell a soul at work is my advice.
Don’t even tell my admin even if i can’t run calls while taking blood thinners.... well I’m not supposed to
I think that’s a really bad idea . What if something happened ?
AF can lead into other conditions .
Some super fit guys like yourself get AF but that is usually after many years of chronic endurance exercise. You could have vagal AF (see link) or lone AF. In your position I would want an ablation, but I’m not a medic and if you are unsure then a second opinion may be sensible.
richardbogle.com/blog/vagal...
I agree, months leading up to being “officially diagnosed” I always knew there was something wonky, but ignored it until now. I really want the ablation route but scared that my district won’t support me and/or I’m told I have to be on blood thinners for the rest of my life which means I’ll never work in the fire service again.
Work out your CHADS2VASC score. This is a scoring system to determine your need for anticoagulants for stroke prevention. Yours is likely to be zero, and current advice if it is zero, would be that you don’t need to take them. You would have to take them for a short period before and after ablation.
Hi, I can see what a difficult situation this is for you. So I think you would want to do everything you can to keep the career you love. The bad news is that neither meds nor an ablation are a 'cure' for AF. But there are lots of lifestyle changes you can make to give yourself the best chance and I'm going to list a few:
Eat a balanced diet with as many plants as possible, don't eat big meals and don't eat near bedtime.
It is possible to over train. Many elite athletes develop AF. You need to be only as fit as necessary for your job.
Try to cut out caffeine and alcohol.
Get enough sleep, no use to say avoid stress!
Much of that might be unnecessary advice for you but I hope something is useful.
Best wishes whatever you decide, I hope you are able to continue your career for many years.
Thank you for replying. Yeah I think I’m the only firefighter I know who doesn’t drink caffeine, I avoid it all costs even if we’re up all night running calls. I used to drink a lot when I was in high school but in the last two years I’ve lost complete interest in drinking and only drink on occasions.
I really feel for you, it’s a difficult decision to make but I just wanted to say that I went on for 30 years with this awful condition avoiding ablation and managing it with medication. I lived with the fear of it happening any second, it took away so much of my confidence. I hid it from people like a horrible shameful secret so they wouldn’t doubt my ability or think I was having a panic attack or I was weak. I put my health last and that was a mistake.
I had an ablation a month ago and even though I’ve found the recovery challenging I’m so glad that I’ve finally faced this thing head on.
I don’t know anything about the fire service but after 2.5 years of dedicated service in a job you are so passionate about I would hope that your superiors would be understanding. Have you met with an EP yet, did they give you any kind of odds for success in terms of ablation?
I had 12 goodish years on flecainide with minimal breakthrough episodes, it was a good drug for me but eventually my arrhythmias took a turn for the worse and I decided on ablation.
Is there anyone that you can talk this over with at work? You might find that they are really supportive and can help you come to a decision.
I wish you all the best, take care 😊
Hi thank you for responding. I agree on the confidence issue. It’s starting to break and beat me down already. I have a wonderful girlfriend who I plan on marrying and buying a house with but right now I’m scared to even buy a house in fear that I’ll lose my job and I’ll be left with a mortgage and no full time job to support us. I hid these symptoms for the last 8 months in fear that I’ll lose my job. Only one person at my work knows I have arrymithias and I had to tell him on accident. One day I was lying down and I started after symptoms so I went to our ambulance and hooked myself up to our 12 lead and my medic saw me doing it so I had to explain to him why. Yeah my EP specialist put me on a month long monitor and in that one month she caught an episode that lasted a few minutes but I converted after standing up. She said there’s a 75-80% success rate.
Please please don’t hide it anymore, I would be surprised if revealing what is happening to you would mean that you would lose your job.
It will only get harder, it looks like it’s quite a regular occurrence, it’s just going to become so stressful for you.
I hid how bad I’ve been feeling for the last 3 years, I knew my problem was getting worse and I was so terrified of not working, having an ablation, accepting it all that I literally struggled along avoiding things and becoming less and less confident and more unwell. I eventually collapsed at work and it was all taken out of my hands. I was devastated but now I’m glad that happened because I was as exhausted from it all.
The odds sound quite good, you don’t have to make a decision about that yet, the first decision you should make is sharing what you know with the people that can advise you at work. Good luck with it all.
I feel your pain. I worked in law enforcement for 7 years when my heart started in. Went to the doctor because every time I went to a call, the adrenaline would set it off. I went to my doctor who said I was just stressed. Finally, it became too much to bear for me and I had to find a new line of work. Over time it got worse and worse and when I went in recently they were able to diagnose me pretty quickly. I’d say you go for the ablation so it doesn’t progress. Are you a member of a union? You should speak to your rep.
Thank you for replying. I’m fine on calls, in high stress calls like fires and cardiac arrests I feel like I’m in my zone. It’s only when I’m laying down to sleep sometimes I get these episodes. Unfortunately no, my district left the local union around the time I was hired which really makes me feel less confident.
If I go the ablation route sometime soon there’s two routes I can take while on blood thinners. 1. They support me the most this way by putting me on paid light duty.... filling paperwork and doing stuff around the station, help Chief with stuff. Or they let me take unpid medical leave for 3 months. I do have one month of PTO saved up.
That’s a bummer about the union. I feel like there have to be some protections in place for you under ADA. At least for the time you heal after you get your ablation. I’d imagine if it was ineffective then they couldn’t support you with reasonable accommodations and that would be grounds for termination. If you have any questions I’d consult a lawyer.
Not many on this site agree with my belief that AF is caused from compromised nerves in the neck or the back or both. Your symptoms are identical to what I have experienced. Lay down get AF; stand up and it stops or do some exercise or movement and it stops. Gradually, AF will happen more often when you do something that affects your neck or back; and it will be more difficult to stop by the usual means that you will learn. Heart doctors don't look at this cause and I have not found studies that investigate it either. Some chiropractors believe this is the cause and some can fix your spine problems and thus AF. After two years of chiropractic adjustments and many challenges with AF that I definitely know is caused by issues with my spine, it appears that I am finally winning and may be on the way to permanently fixing my back. It has taken two years of adjustments every week and then every two weeks to finally get T5 so it does not need to be adjusted and now my AF is much better. C1, C2, T1, T2 and T5 are the main vertebra that compromise the nerves through which the brain tells the heart what to do. Other vertebrae from C1 to T5 could also play a part or even vertebra in lower parts of your back. I have tried many things to get this far. I do not take any medication and am 71.
It is possible that you have injured your neck or back at some time and even though you think you don't have symptoms, you still could. Go see a corrective chiropractor and if you find out you have vertebra that need attention, then try this first. Being young, you should respond to adjustments more quickly than an old person like me.
Older people make collagen less efficiently. I have been taking collagen supplements for the past three months. The discs in your spine need collagen and are poor at receiving blood. I have a device called a Scenar which can help promote better blood and oxygen flow to the discs. This could be helping as well. If you want more information on this, message me. Ablations and drugs are stop gaps only. They are not cures. If you read many posts on this site, this will become painfully obvious. You should look for a cure before trying drugs and ablations. If you can function well while in AF, then keep it a secret for a bit longer until you explore the spine possibility. I have been doing this for 6 years and have not had any serious issues as a result. Going to a chiropractor is often more acceptable than going to a heart doctor.
I think you've given wise advice in your above post.
It's interesting to read the way that you have cured yourself. I think it would be helpful for others who may miss seeing it here if you put your information in a post of your own. I know you have a been member of this forum for many years and I always enjoy reading your innovative posts.
I'm one of the few people on this forum who believe an ablation should not be the first step to solving the problem of AF. I just wish that I'd had the current advice given on this forum long before my very first ablation so many years ago.
I agree with your belief, if it has helped you that's all I need to know.
Jean
I'm a paramedic and have just had my 2nd ablation. I'm the 3rd person on my station to have PAF and get ablated. Two of us got cardioverted during the procedure. Never once was there any talk of losing my job. You'll be light duties for a few weeks and back on your pump eating chicken and watching backdraft before you know it. Get the ablation done, whilst your waiting for it take the flecaininde and anti-coagulant, it was 6 weeks pre procedure and 6 weeks post for me regards the rivaroxaban. Be honest, but have the ablation. Good luck pal and stay safe. J
Wow thank you for replying, I haven’t personally heard from someone in our profession. Some might be like me and afraid to talk to chief about this in fear of the outcomes. This profession means the world to me and the thought of losing it crushes me, reading the NFPA on physical fitness isn’t helping me at all lol I plan on going to medic school in the near future. For now I love being a rider when my shift medic needs help on a serious call and I definitely love being a hose monkey. Thank you so much
Do you live in the UK?
I live in the U.S
Ah! I thought you might.
You have excellent healthcare (my daughter used to live there)
but, I know from a friends experience that having a health condition and continuing to work in certain working environments is not always as straight forward as here in the UK.
I am not sure how the USA sickness pay/benefit etc compare to the UK?
Not sure why blood thinners one month before and three months after. I would seek a second opinion. My understanding is that you may only need blood thinners for one month after the ablation. That is what I received
Thank you for replying, yeah my girlfriends mom has full confidence in my EP specialist right now but also agreed to get a second opinion or at the very least wear the monitor for another month and see if we can catch a longer episode.
I feel for you!
Put your health first pls
go for a second ,third or even fourth opinion it is not easy to find a very good EP drs!
I was told the earliest to do the ablation the better!
I wish you luck with whatever decision you are going to make
Thank you for replying, I agree that the earlier the better and no time is gonna be the right time to have surgery.
I have had P/A/F now nigh on 20 years and I too had a very stressful job and that in turn exacerbates this condition, some call it a fight or flee response and of course the profession you have chosen is far from stress free however the one thing you are is fit and with a long and happy future in front of you so my recommendation, if you are in the UK, is to ask to be referred to Doctor Schilling, who is at the very top of his profession with specialisation in Atrial Fibrillation, and get his expert advice, your doctor can refer you. If you were older then my response would be different but at 23 years of age you would, I feel sure, benefit from this great doctors guidance and advice. Good luck x
Thank you for your response. Yeah this job is like no other in the world, amazing but can be brutal at times on the nerves. Unfortantly im not, I live in Arizona in the U.S which sucks when it comes to medical insurance. Maybe I can reach his office from over the phone for advice? He’s gotta be busy so it’s a long shot.
I will get the information you need. By the way I loved Arizona, visited only once sadly, my aunt, a Canadian national used to go and stay every Canadian winter on a park home site in Yuma. Will be back with the info shortly on Doctor Schilling.
Here it is:- google.com/url?sa=t&rct=j&q.... I hope the link works - it is Professor Richard Schilling, Cardio Consultant based in London (London Bridge) so if this link doesn't work that's what you would Google
I am in a similar situation to yours regarding onset of paroxysmal Afib and time returning to Sinus rythm. Regarding Afib being a progressive disease, my Cardiologist told me that progressive and permanent damage to the structure of the heart occurs when the heart is in arrythmia for long periods of time such as in permanent Afib, etc. This is not the case when you return to Sinus in a day or two, much less a few hours. Hearing this, for the time being, I am taking the medication route with 150 mg. flecanide and 50 mg. Metoprolol daily. If you can live with frequency and length of episodes as they are now, you can wait on the ablation decision. At least, that's what I am doing.
Thank you replying, yeah I’ve never had an episode that didn’t start with me laying in bed, or one where I couldn’t self conversion after standing up for a few minutes or showering. I have a ton of thinking to do but responses from people like you on this forum is really helping me. I feel a little less lost.
You are very welcome. It sounds like you have vagal Afib, like me. It almost always happens at night. Also, occurrences after a meal is one of the hallmarks of vagal afib. It's origin is in the vagal nerve. My main point was that with such short durations in Afib, your heart isn't being permanently damaged as in other form of Afib and ablation isn't as urgent as in those forms so, in that regard, you have time.
I had infrequent episodes of AF for years and just hoped it would go away but it doesn't and last year started getting monthly episodes. It is a progressive condition. I started Flecainide and that controlled it. You could try meds and give yourself some thinking time. To be honest although you love your job it doesn't sound very secure if they could make you redundant for a temporary ill health issue (having an ablation). Where do you stand if you have an episode of AF on a shout? You can't do CPR easily whilst in fast AF (well I couldn't have)
Although I had no AF on the Flec I opted for an ablation and have recovered well to date (4weeks).
I'm on apixiban for 3months.
I'm 59, also lone AF. First episode in my 30s associated with a thyroid issue which resolved without treatment. Then in my early 50s started again. If you know your triggers you can to an extent manage it and the meds can control it. Talk to your cardiologist EP. Presumably there's a waiting list for the procedure so you have time to try the antiarrhythmic meds and think it through. Your health must come first. What advice would you give a friend in the same situation?
Let us know how you go on.
Amanda
Thank you for replying. I’m gonna call and schedule for an ablation cause there’s most likely a wait list. While waiting I’m gonna try some antiarrythmics and see how my body reacts to those. Yeah I strongly believe that my triggers are laying down in bed and especially after a meal. To date, I’ve yet to have an episode where I wasn’t in a supine or semi supine position. The issue in the fire service is that it is a VERY competitive field. I’ll admit and take confidence in saying that I’m a great fire fighter and a great medical provider but there’s always someone who’s equally as qualified who doesn’t have these medical issues. I’m hoping my fire district will support me. And to date I’ve yet to have an episode that compromised my ability to work and run calls.
I think you'll feel better for having made a plan. Esp if meds control it and also if you can control the triggers to an extent although it's a pain if lying down brings it on since that's hard to avoid. Some people find lying on their left hand side triggers it. Might that affect you?
Are you in the UK?
Honestly right now I just need a plan cause I feel so hopeless. All I’m thinking about is the prospect of becoming a failure. I’m afraid I’ll lose my job and won’t be able to support a family with my girlfriend, buy a nice house or live a fulfilling life. No matter what position I’m in while laying supine I’ve had an episode, tried laying on my left one night hoping it would reduce my symptoms but then it felt like a horse was kicking me in the back the whole time, it was a terrible senesation. No pain, just a sensation. I live in Arizona, USA and everyone knows how great our medical system is here lol
Hmm that's a real pain if any supine position can set you off.
Think someone posted a link to info on vagal AF have a look at that.
We are so lucky with UK health service. I can't imagine what it would be like having to think about whether I could afford treatment.
I hope you get some peace of mind once meds do their job and you can feel in control.
😉
Hey! I have been diagnosed when I was 22, I had 2 episodes since. The first one stop by itself and the second one stop when I took flecaine. For months I lived with fear that AFIB comes back again, and it did the day after my birthday. I decided to be ablated on November 2018. 5 months later i didn't have any episode and I feel better than ever!
As people said AFIB is a progressive condition and you need to know yourself and know your triggers, here are mine: lack of sleep, long period of anxiety, overthinking and too much exercise with coffee.
For now I don't regret this decision because the fear is gone, you need to think and stay positive even if it is hard, people are kind here and if you have any question, just ask 
Thank you for replying. I try and avoid my triggers, I don’t eat close to bedtime anymore. How was your ablation process? What drugs did they prescribe you and how long I’m duration did you take those drugs? Thank you
It was cryoablation, it took 2 hours then I took blood thinner for 2 months then I've been off drugs since.
You recommend the ablation route over drugs?
Well, I took drugs and it didn't work for me I had 2 attacks in 7 months the first was on March and the second was on October. I was afraid to do the ablation but now, I'm peaceful. Of course there are drawbacks like tiredness, drugs, cost of ablation but the most important question you need to solve is: what kind of life do you want?
I want a drug free life where I can continue to fulfill my duty in the fire service. We’re in similar age and I hope my rehab from the ablation is quick and effective
There are no guarantees so you have to work on the basis of probability. Your condition is likely to get worst over time, drugs will provide a rest bite and this could go on for many years but they will have side effects which could be minor or in some cases debilitating, during this time you will always be prone to another attack. Not a good condition in your job.
If you have an ablation it is likely to be successful (at the very least it will significantly reduce the chance of an attack), you will not need to take drugs and will lead a normal life - this is good for someone your age.
My advice is this is a no brainier, get the ablation, yes you will be scared and yes it may take months rather than days or weeks to recover but you will get your normal life back and no longer worry if your going to get an attack.
In your job you have to make risk assessments, getting these right will save your life, you have to factor in the potential of having an attack whilst on a call. You may also find that any insurance you have may be limited by your condition? Well worth checking out.
You should also check out the need for anticoagulants for your current condition. These are not blood thinners they prevent the blood from clotting and in doing that they reduce the risk of a stroke. People with AF or A flutter have an increased risk of blood clotting and a stroke, that is why many medical practices provide anticoagulants as a matter of course for your condition.
You have a serious decision to make, your heart will tell you one thing and your head another, you have to make the risk assessment yourself, to help I have offered my opinion.
Thank you for your reply. Do you think going the ablation route will hurt my chances of continuing to work in the fire service?
Do your employers know of your condition, they may insist you get treated. Please also check out your insurance cover with your condition and also the need for anticoagulants. You do not have a particularly serious condition but a little checking out is advised
No I haven’t told my admin, I had suspicions of my condition but only a few days ago got the official word. I’ll be calling my insurance soon to see what I’m covered under. I just wanna be able to work and serve in the profession I love and I’m afraid it’s getitnf ripped away from me.
Your understandably in a dark place right now, but be assured your going to be fine. If you want to know more about your condition put "yorkcardiology" in your YouTube search, there you will find many videos by a cardiologist Dr Gupta, look at the relivant videos to your condition (these are months or years old but they are there). If you feel it useful you can also have an Internet consultation with the good Dr which will further put your mind at easy (this will cost around $90). I have been suffering for 23 years and only just had an ablation in February so I do know what your going through.
Thank you so much for your insight!
I ment to say that I do not know the position between yourself and employers to comment but certainly in the UK the Fire service would support your treatment 100% and you would get full pay throughout. I would be really surprised if any civilised countries Fire service would not do the same.
I agree, I have a good enough reputation and good relationship with my administration. I hope they support me
I hope you get sorted matey. It's a difficult decision. All I would say is an ablation is an invasive procedure and should be treated as such. Some Cardiologists throw the ablation word around like sweets. I am not trying to scare you and obviously many are brilliant for people. But there are also risks as with any procedure. Just research it thoroughly so you are informed and totally confident it's for you. Whatever your decision, super good luck, life throws crap at you and it's about overcoming it and moving on.
Thank you for your support man, yeah I feel like I’m in a really deep place right now between difficult decisions
I am humbled by your bravery and your commitment and love of your work. I can't advise on the pros and cons of an ablation at your age, as I haven't had an ablation and I certainly didn't have AFib at 23 years old. I just wanted to offer support, everyone on here will be thinking of you, so please come back and tell us how you get on. My very best wishes.
Thank you so much for your support.
Hi mate, well done for facing up to your situations and trying to deal with it sensibly and thanks for the great job you Firefighters do!
I’m curious to know why having blood thinners is a no no with your fire dept; could you explain?
Best of luck with your outcome.
Thank you for your reply. There’s this biiiiiiig book that all modern fire service departments fall back onto called NFPA. NFPA 1592 states that blood thinners effect our ability to work cause of possible hemorrhaging in trauma. Say if the roof fell down on our head while in a burning house or if we get a cut while rescuing someone.
I understand, you’ll end up bleeding out yourself otherwise. Thanks for your reply and the best of luck.
Just wanted to say that some doctors will advise you to take anticoagulants based on the very fact you have AF and the increased risk of stroke that presents. So even if you don’t choose to have the ablation anticoagulation might still be a choice you have to make.
Its well know that AF can affect athletes and those who are physically very fit. In such cases it may be that the prognosis is different, perhap considerably, better, than for older people who have AF for other reasons. This, of course, is to assume that your AF is of this “athletic” type; the fact that you are only 23 *might* point to this.
In you position, if you have not already done so, I would suggest going back to your consultant and asking him to be really straightforward with you and say what he thinks the implications of your AF are for your job -both short and long term. Also try to get some idea of why he thinks thinks you have acquired it at 23. I was told it was on the rise amongst younger people, probabaly because of bad diet, obesity etc. - it doesn’t sound as if you fall into this category however. For what its worth, I know two members of ambulance crews who have AF- although I suppose their job is less risky from the point of view of anticoagulation.
You realize some blood thinners have readily available antidotes? I'm on pradaxa because it was explained the effects could be reversed at E.R. if necessary.
Ablation is the way to go. You will get your quality of life back and you may also be able to get off all meds, including blood thinners. Your doctor would be best to guide you.
I feel for you! A good cardiologist can help you make the best decisions going forward. I'm not sure what country you're writing from, but here in the U.S. your job is protected by law. You are correct regarding the anticoagulation necessary for an ablation, but as others have posted, you may not need it over the long term. If you choose the ablation, you will likely need to take several months off. The elephant in the room here is the work related stress you're experiencing on an ongoing basis. It sounds like you are calm under fire, so to speak, but that doesn't negate the physiological effects of stress on your body. The chronic high stress will be an ongoing risk factor for you should you choose to stay in your chosen profession. I speak from experience as I am a RN and mother of a currently 34 year old son who is a paramedic disgnosed with PAF at age 30. Don't view this as an obstacle, rather view it as an opportunity-best wishes going forward.
If I were you, I’d tell no one, and do the ablation. I am relatively young (48) to have this condition, and you are half my age. My ablation worked great, and hopefully yours will, too.
AZMTBer95 you will be on blood thinner either way, blood thinner is usually part of the drug used to control your afib. If you have the ablation you could be off the blood thinner in a few months but that not even a sure thing. You have to decide what would benefit you long term (you are very young) I have controlled afib I had an ablation 5 years ago but still take Pradaxa and sotalol but feel great, haven't had an episode for many years. Afib is a progressive disease but can be controlled but not cured (HATE TO SAY THAT) But I live a normal happy life now and I have cut myself thousand of time working on stuff, I didn't bleed anymore than before I took Pradaxa. Remember you have a lot of years to live and afib can make you very sick if not controlled and a strokes from afib would most likely end your career. Do I recommend a ablation, I will just say it made my afib controllable it did not cure it but life was hell for me prior to the ablation. Get well and think about your future, your longevity, Some times changes in life our required.
Thank you for your response. You you feel my ability to work in the fire service is compromised either way.... drug route or ablation. My EP wanted to start me on antiarrymics only. She’s taking my preofession into account I believe.
I completely understand how you are feeling. I had my first episode of AF 4 years ago at the age of 24. I had the exact same concerns as you at first. During the last 4 years I’ve had two further episodes lasting a couple of hours each. I was highly symptomatic during episodes with rates hovering around 200bpm. I had a Medtronic Linq installed over the last 3 years.
3 days ago I had an ep study with an ablation and believe it or not they found a different type of arrthymia that was likely triggering the AF (AF was not triggered during ablation). I was diagnosed with atypical avnrt, an uncommon but known form of SVT that can trigger AF usually seen in younger patients. I never had SVT caught on a monitor but each episode of AF that I had was brought on by an extraordinary fast regular heartbeat that degenerated into an irregular rhythm. The avnrt was successfully ablated along with a pvi that was confirmed with adenosine challenge.
I’m not sure if you’ve already done this but you should get an echocardiogram or a cardiac MRI to ensure your heart is structurally normal. If it is, you will likely have a high chance of success with ablation. AF can be successfully eliminated in the majority of these types of cases. I am also very active and fit with no other comorbities so my EP had a high suspicion that was AF was being caused by something else.
As far as the ablation goes, it wasn’t too bad. The hardest part for me was the anxiety leading up to it. Mine was done under general anesthesia and I woke up without issue but was a bit dazed for the first day. The scariest post procedure experience for me was migraine aura which was started to substantially subside over the last day. If this came back later in my life, I wouldn’t hesitate to have another one.
Please let me know if you have any questions about the ablation. In my opinion, with respects to risks, I would recommend it if you find an experienced operator in an experienced center that has an excellent track record. It beats having to take meds for the rest of your life and having to worry about more episodes.
Thank you for your response. Yeah I had an echo done before I was referenced to the EP. I have a structurally strong heart, cardiologist said my heart is so strong it might actually be amplifiying the skipper beats. Do you think having an ablation is my best option in regards to being drug free someday/ months after the successful procedure? Honestly if I could find a way to stop this from progressing I would be fine living with the frequency and duration I currently feel. I know that a complete cure is impossible but if it stopped it from getting worse I would be content with life. I just wanna be able to be a firefighter, that’s all I want.
A complete cure is not impossible. This procedure has only been around for 20 years and there is people who have had one or two ablations and never had a single episode again. It is more likely if you are young, fit and have a healthy heart which is not the case for the vast majority of people with AF. Later in life if you develop diabetes, become overweight, hypertensive or develop another risk factor you can develop it again or if you have a break in PVI lesions or another spot that is firing in your atrium. This is why it is extremely important to go to a competent operator that will do a comprehensive EP study along with a durable PVI.
I am an engineer and developed heart monitors for my first few years out of college. During my time I came across a few people with successful ablations of AF who have not have recurrences that had them many years ago when they were almost considered experimental. I cannot stress enough that the results and risks of this procedure is operator dependent and you want to ensure you found the best of the best in your region.
If you have true lone af, with no other comorbities and live a healthy lifestyle you should be aiming at complete elimination of AF, not worried about the progression. If you decide to go the ablation route, the sooner the better, AF is not good for our hearts. Far too many get the ablation too late and may expect the same results as someone who is newly diagnosed. I had mine after 3 episodes, a total of 6 hours in AF over 4 years verified by a Medtronic linq in my chest. That was enough for me to have someone go into my heart and figure out the issue. Here’s some videos to view.
Hi curt, how interesting, I had the same, SVT triggering AFib. Had an SVT ablation and my EP is certain that will be the end of both the arrhythmias. Glad to hear you are through the other side and doing well 😊 take good care
Hi Kelly, I am so glad to hear that! Apparently my doctor has said he’s seen it a few times over the years. I was always wondering what the super fast heart rate was when I ended up with an episode of AF. I remember my first episode I was with the EMTs and I said “oh it’s finally over” and they said it wasn’t but it slowed down and became irregular. It feels good to find the cause. Cannot wait to feel like myself again, still pretty tired and sore, but nothing too bad.
Take it slowly and remember I am here if you need to ask any questions, I’m am 5 weeks in front of you.
Hi, I am in the US (WA) and work in local government management, but not in fire service. I oversee the chief however. I am 56 so much older than you, but relatively similar onset of PAF, but we are all unique. Relatively good health and fitness, 30 min cardio most days. Mine gradually got worse. From my first episode till ablation it was 20 months but I did not know what it was until around a year after the first episode because it never got captured on EKG until then. I am currently 2 weeks post cryo ablation. That procedure is worth investigating. My stroke risk score is zero so I only have to do anticoagulants for 3 weeks post procedure, one week to go. I did not need any before. They started me on flecainide after the procedure but stopped it after 1 week as I was feeling a little off on it. In theory I was to be on it for 90 days for the “blanking” period, but they said the “cost” in my side effects did not outweigh the benefit. Pre procedure I was only on rate control with diltiazem and am still on it. I have had one short episode around 60 seconds maybe less since the ablation. Some ectopic once in a while. My EP is one of the best in the region and has done thousands of these procedures and has a high success rate. As a fire district employee you likely have very good medical coverage, but yes, the EPs are busy so you will wait some. We have outstanding medical care in the US if you have access to it via insurance, our issues are not in the quality of care (they are around access and cost), overall we have access to the very best technology although for some things our FDA approval process lags approving innovations from other parts of the world. But this is not one of those areas. Find an EP who is a fellow of the Heart Rhythm Society at hrsonline.org. I just searched for Phoenix on their search tool and there are a number of them. If a 56 year old in decent shape with a stroke risk score of 0 does not need anticoagulants prior and only 3 weeks post ablation seems like you might be similar. Be sure you get all the procedures and tests pre approved for insurance, and that the EP and anesthesiologist are preferred providers for your insurance. Your job is protected by FMLA. You will be off for a bit and then light duty if they will allow it. You will need a doctors note to return to full duty. I assume you are part of an IAFF Local. That provides you job protection as well for legitimate issues like this, you are not trying to game the system. We are all unique, but my sense is you can get an ablation, you will miss some time, then maybe some light duty then back to full. Get second and third opinions from EPs from that web site if the first one wants you on anticoagulants for months before and after the procedure. Google cryoablation using Arctic Front. There are of course no guarantees on anything, make the decision you feel is best and try to be at peace with it. My faith is the center of my life and it grounds me in peace although I struggle and worry etc sometimes, especially about this. Everyone on here understands the emotional dynamics around this, but there is definitely reason to feel hope and confidence for a good outcome. The LA Dodgers closer has had a couple ablations, read about him it is encouraging.
Wow thank you for your thorough response, yeah I like to think I’m in pretty good shape. I work 3, 24 hour shifts a week and I’m shift we get some really good workouts in and I lift and mountain bike/run on my days off as well. Unfortunately my district left the union around the time I was hired two years ago. Do you believe I’m a successful candidate who can keep working in the fire service for the long term or am I compromised? Thank you
Redsoxwin - interesting to see Diltiazam is prescribed in the USA, I have been on it for just over a month 240mg (uk) and feel much better than when I was on Bisoporol
Interesting, I am on 120 mg, not sure if I will stay on it long term, I might want to for BP. First I was on metoprolol and did not like side effects. In emergency room one time they used diltiazem IV drip and a beta blocker to convert me. I tolerate the calcium channel blocker much better. BP has been up a bit since ablation if it does not come back down might need more BP meds we’ll see
You seem to be on a low dose. Here in the uk the medication dose starts at 180,240,with 300mg being the highest. Interesting to know you had it through IV not heard of that before.
Yes, I think 120 mg is the low end of the dosing spectrum, it may need to bump up we’ll see
I think there is a path for a long career in the fire service, but there is some uncertainty you will have to come to terms with. I am aware of NFPA standards but was not aware of the one about anticoagulants being maybe a disqualifier. Do a “worst case scenario” analysis. No ablation, EP wants you on rhythm control and rate control meds, and anticoagulants. You might be disqualified. You could ignore the advice re anticoagulants so as not to be disqualified and then keep working and see how it goes, but there is some risk to your health if they really think you need them. Maybe it works for even a few years but then it doesn’t anymore and then you are older and maybe your stroke risk is higher and you end up on anticoagulants anyway and face the same issue. Or, you get an ablation and do not need long term anticoagulants and then after a few years it comes back and you need another one and maybe at some point anticoagulants. Back in the same boat. So there is no way to predict it. However, my research indicates you have a better chance of having many years (potentially even “forever”) afib free and no anticoagulants with an ablation, a better chance than without it, because the meds from what I have read will not work “forever.” Maybe they do for some people. So it could be that your best chance for a full career in the fire service on the line is with an ablation. No way to guarantee it though. I would have that conversation with the EP re the prognosis for needing long term post ablation anticoagulation vs. needing long term anticoagulation if you do just meds. Maybe meds for now with no anticoagulation will work. Then later get an ablation if needed. I have read that PAF is progressive however and you may be an ideal candidate for ablation.The EP is of course your best advisor on that. Worst case if some day you end up needing long term anticoagulation there are other jobs in the fire service. Look into Fire Prevention, work as a Deputy Fire Marshal and advance to be a Fire Marshal some day. Do training around the fire code and arson investigations and fire inspections etc, get the corresponding certifications. Larger fire departments have more opportunities like this of course. Bottom line no one can guarantee you a long career in the fire service, even if you did not have PAF. But there is a path forward through which you could. It is always a good idea to have a back up plan and Fire Prevention could be in your back pocket. Law Enforcement (be a cop) is also a good public service career. There is a shortage of good young people wanting to enter that profession and therefore lots of opportunity for the right person, so that is an option too. You can always go back to school and get a degree as well and change careers. It might delay some of the financial goals, but people do it all the time. Keep your chin up, talk to the EP, make your decision, follow that path with confidence, have a back up plan, and try to be at peace with the uncertainty in life, live each day and be the best you can be in that moment. I still try to tell myself that every day. Also, with most of the newer anticoagulants, there are antidotes, so maybe it really is not a disqualifier.
Hi buddy, well as a former cop I can tell you that you have to potentially face up to the fact you may have to consider your options. My first experience of AF came on duty when I was tackling a guy with a knife who was trying really hard to ends my life. I assumed it was adrenaline, but this was the first sign I had AF. Then it presented itself again and again until I was forced to have an ablation. The medication route did not work for me, and this was the only option I had to ensure I was fit and well.
I am assuming other than the AF you are fit and well doing the role you do, which was the case with me so the cardiologist suggested a double ablation to prevent it reoccurring in the future. I have now left the police (not because of the AF) and am working as an Operations Manager on the railway, which is a safety critical job. I basically manage fatalities and incidents such as train crashes etc. When I joined they performed a pre-employment medical and I passed, but then I had to re-attend as they gave me a non-safety critical medical and the Dr said I was not fit to work alone or drive company vehicles, both of which my job requires. So I went back to my cardiologist, who wrote a letter explaining I am fit for the role, and then they raised an objection to me being on blood thinners, as I am at more risk of an intracranial haemorrhage if I were to fall and hit my head. But like you, I have to wear hear gear at all times, so couldn't see how I present any more of a risk than anyone else. Well after a battle I am reinstated to full status and am able to work alone and drive in a safety critical environment.
I get you are concerned as working emergency services is a calling and to me more than a job, so the thought of losing that is scary, but your health comes first every time. I had to concede that whilst it might seem unfair I had to reconsider my life. It's not easy and you may not even have to consider this, but I hope things work out for you buddy.
Thank you for your insight and it’s important to hear from someone who was in public safety as well. I really hope I don’t have to make the tough decision to leave the fire service but I feel like the evidence is stacked against me. I’m trying to think of other jobs or professions and I’m struggling
Dear AZMT, even though you are young, you should still be on blood thinners. I am young-ish, female and had PAF, my doctor shows not to put me on blood thinners and I had a stroke. I had no high blood pressure while in a normal sinus rhythm but I had 3 strokes in my speech center, came through it well because I’m in great shape for my age, I’m 58. If you have insurance, get the blood thinners. Don’t risk your health at such an early age! Research the LAA in the heart, they do a procedure called a Watchman to it...
Hi thank you for your response, you feel as though I should be on blood thinners for life even if I do the ablation? So far, my ep said the only reason she’ll put me on blood thinners for a short time is if I do the ablation. If not, she’ll do antiarrythmics.
There are a tremendous amount of hospitals in the USA that are incredibly competent to perform ablation procedures and it might help you immensely if you obtain a couple of more opinions. Don't rule out sleep apnea. You're young enough to get those opinions. A few more months won't matter but always good to get the right consult. Maybe a cardio version is all you need... I live in St. Louis and Washington University School of Medicine has a great cardio lab at Barnes or any of the area hospitals. Take care.
Best Wishes - my husband is a retired Firefighter (rose the ranks to Chief) and after the Fire Department he became a Deputy State Fire Marshal. I understand your passion and know many who have that passion that overcomes you. However try not to worry so much about the future- take it a day at a time. You are young and that’s to your advantage- research and follow your gut feeling- sounds like ablation is the way to go- you don’t want to be on meds already - be honest at work. It’s been on this site that Dr Natalie in Austin Texas is an excellent EP- check it out
Again best wishes and I feel positive you will have a future in the Fire Service- my husband wishes you the best also
Read your contract of employment and seek advice.
First, I’m really sorry this happened to you. That is a kick in the stomach. I think if I were you, I would have the ablation and be up front with your district about your situation. Like you said, you’ve worked hard and you have a good relationship with them. Your health comes first and you must do the thing that gives you the best chance at returning to the work you love in the shortest amount of time. I’m assuming also that you’ll have to be on blood thinners potentially for life if you don’t have the ablation and go the medication route instead. At such a young age, I would imagine you want to avoid reliance on meds for such a long time.
Another thing to consider is this: afib tends to respond more favorably to ablation when it’s done early, rather than years after diagnosis. I don’t have afib, but I had two other types of arrhythmias (one svt and one left ventricular) and I had them both ablated in one procedure. I am 2 1/2 months post ablation and have my life back. The feeling is indescribable.
I highly recommend getting a second opinion. I understand your dilemma— I too work in a high stress job that I love and I worried that I wouldn’t be able to continue in it. I still think about it, because my arrhythmias can come back. But I wanted the best chance at a normal life free from the fear of episodes and from medication side effects that can be just as limiting.
Talk to your superiors. They may even have gone through it themselves or know other firefighters/EMTs who have. They could be a great source of information and support for you.
Best of luck and know that you’re not alone. I had my ablation done by Bruce Koplan, chief of the arrhythmia service at Brigham and Women’s Hospital in Boston. He is phenomenal. Best decision I ever made about my health. And they took amazing care of me during my mostly awake procedure. No pain at all.
Kelly
Thank you so much for sharing your story, it’s indeed a very scary and sad time for my family and me right now. Considering I was in the market to buy a house and start my life with my girlfriend it really has put a huge roadblock in the way. I have a lot of phone calls to make in the next week. Before I commit to having the ablation I wanna make sure I’ve crossed every possible avenue off. I’m gonna have a sleep study to see if sleep apnea could be the cause, seeing how everyday, even after a full 8 hours I feel run down and exhausted. I’ve caught myself a few times waking up after not breathing as well. Yes, I agree that the ablation route is the best option and I plan on being very aggressive with my treatment. All I can hope for is that the ablation stops the progression of this terrible thing we have. I only have episodes once a month and so far, only when I’m lying supine or going to sleep and I can convert by standing up for a few minutes. I’ll be able to sign up for long term disability soon when our open enrollment month rolls around in June, jus in case the worst happens.
Maybe this tip will help you in the short term... most of my episodes began when lying down, so I stopped lying down!
I now sleep with several pillows and a large V shaped pillow on top to stop me rolling out of bed :o) Or sometimes I sleep in a very comfy recliner. Not one lying down AF episode since!!
I’ve honestly thought about this lol have you ever had episodes when not laying down?
Yes. Well, I'm going to be brave and say that, 'I used to'. If you see my previous posts I gave up all my meds because I felt they were making me worse after a while. Since I gave them up 6 weeks ago I stopped having almost continuous palpitations and not one AF episode. Before that, I tried all the usual stuff for a year, lost loads of weight, avoided all known triggers etc and was still getting episodes bi-weekly.
The other thing I did 6 weeks ago was explore a spiritual aproach. Now I know this is not for everyone but I was desperate. I contacted an Emotional Freedom Techniques practioner (EFT), she is actually in the USA and worked remotely with me. Conincidence or not, I do not know, but I have been AF free ever since. AND I have had many known triggers such as 2 weeks of flu, and in the last week, been hospitalised with acute pancreatitis. And no AF :o)
I wish you all the best on your AF journey. Don't be afraid to be still, be present with yourself and ask your body what it needs to heal. And then listen... :o)
You may find it useful to consult a qualified, recognised nutritionist to eliminate any food excesses or deficiencies. If you have a look at carneuny's posts you may find some useful ideas, along with a full spectrum blood test to look at mineral levels with special regard to magnesium levels.
Hi WendyWu20. I did all that you are doing and more. Got rid of drugs, noticed the night time AF, slept in chairs, adjustable beds and pillows. After two years of chiropractic adjustments, taking collagen and using my Scenar devices, it looks like I may be on the way to getting rid of AF. At least my process is better. You may wish to try the chiropractor route.
Hi, I would hope that your employer would support you through any treatment you require. However, I am someone who developed lone PAF approx 4 years ago now (I'm 45) and opted for the choice of anti-arrhythmia drugs instead of ablation. I have happily been taking daily flecainide since which controls it for me, 2x50mg. I have since run marathons and competed in triathlons and have recently reduced my dose to 1 tablet a day at night. I would never rule out ablation, but for me, I am happy as I am - for now at least. Good luck.
Hello - i’m sorry to hear that you’re going through a tough time but I would most definitely speak to your employer. I too had PAF probably for some time before being diagnosed. What followed that diagnosis , hospital trips, procedures, tests was all pretty scary and mentally exhausting. My PAF sounds similar to yours in as much as I only noticed it when I would lay down. Never noticed it otherwise. Then one time I went to see my GP for chest infection and what I was told from a child was a heart murmur was infact PAF, I just happened to be in it at that time. I didn’t feel any different to I did normally as I guess I’d just learned to live with it when it happened. So armed with this news and after seeing a cardiologist for guidance as I drive a lot and spend a lot of time on sites etc I sat down with my line manager and talked it out with them - they were very supportive and I explained to them what I needed to do to get back to as near to normal as poss. I decided to give medication a try for a around six months taking flecainide and bisoprolol daily which was ok apart from some side effects but the beta blocker bisoprolol didn’t agree with me and I was told that I would be a good candidate for an ablation in sept 2017 following some intermittent break through AF so I took apixaban, (anti-coag) for a fortnight before a couple of months after - no longer than that as my chads vasc score was low - I suspect yours would be too- although you’d need professional medical guidance on this. So far following ablation it’s all been kind of ok, I still worry like hell about it and i had a blip in June last year for a few hours where I had AF but nothing major as been there before and I sure I will again I guess at some point - but it’s all about how the symptoms effect you, I could always seem to function fine however some others can’t - its a real kind of ‘no size fits all condition’ with no two people the same.bAfter my ablation and upon stopping the flecainide I swapped over to a different beta blocker atenolol as I was given the choice to continue taking it as a procaution following lots of ectopic runs after the ablation and to give my heart a little extra guarding and now I live a normal life except for a few bumps and ectopics/flutter which I didn’t have before I had the ablation but as my cardiologist said my heart wouldn’t be the same after and I would have to expect a few blips and bumps everyday and although these can be disconcerting they are harmless as long as I don’t over eat or forget to drink in moderation (have done a few times - but remember everyones different!) and make sure I’m active as much as poss then there’s not much more you can do. Speak to a cardiologist- fully understand your condition, find out what your triggers are if poss, speak to your employer about it and again explain what your options are and what they can help you with (union rep? If you have one) as being anxious and worried at work about all this going to help you at all and can also be a trigger. I hope you get this resolved and get the right answers and path for you and remember you have options.
Hi thank you for sharing your story. I’m gonna get a second opinion here soon and a sleep study just to collect as much information as I can. I just wish I had some garuntees but so far I’ve learned that this disease carries no garuntees with it. I need to honestly know, is this something I can continue to work with considering I need 22 more years of full time service in order to retire or do I give up now and find a different career.
Hi lots of people work and have normal lives. In the early days of having this thing I was unsure about everything and every little twinge and ache was a worry. I was convinced I wouldn’t be able to work and do ‘normal stuff’ but I met a paramedic who came out to me when I had a odd run of AF - told me a few facts about it and about how he copes with it. It’s a pain in the arse but I promise you will feel better and more confident with it as you go along. It’s funny that as soon as someone puts a name to it you feel different about it and take it much more seriously and rightly so - but you’ve put up with it before? . There is no guarantees your right but a good cardiologist will be able to give you some and put your mind at ease. It’s important even if you have to pay to get your mind in the right place to deal with this and no exactly what’s going on. There is all sorts of measures they can do to record your heart and from those diagnose what’s going on.
Dr Idris is an EP in Gilbert AZ. He will listen to you and work with you. He will offer options. He did my ablation and I am almost 70 Unfortunately my episodes came on with physical excretion. I strongly recommend him
Was he able to treat your condition enough to be in the realm of “cure”?
There is no cure but the ablation helped. After the ablation I had 4 episodes. The last one was October. I have an antiarrhythmic drug that stop helps when I start having symptoms. But I have not needed it since October. I feel that the anxiety makes it worse. So my primary care prescribed anti anxiety drug for me and that has helped control the anxiety. I feel pretty much like my old self. I walk instead of jogging. I don’t know if this helps. Keep coming to this forum for suggestions and support as needed. It has helped me. I wish you the best
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