Hi, new here, I am a 52 year old woman in the UK. I was diagnosed with AF just over a year ago following a paid for general health check. I was given 2.5mg bisoprolol by my GP, which I took, and an anti-coagulant which I did not take. I had a mild stroke last October. Now on Rivaroxoban. I had cardioversion in April but it did not work -- came too late.
I have controlled, treated persistent AF, with an average of 80bpm on the medication. While I am aware of it, I have relatively few symptoms - I don't feel tired, I don't get breathless, I don't get events or attacks, I walk my dog twice a day, I have lost over 3 stone through diet and exercise with still another 3 stone to lose.
I am now facing the hardest decision of my life -- do get ablation before that is too late as well? The cardio I discussed it with says I am a borderline case because my symptoms are not that bad but that it would be a 'reasonable thing to have done'.
Is it possible to live with this or is getting back into normal sinus rhythm, at any cost, the name of the game here?
While it is true that success rates for AF ablation are lower for persistent than paroxysmal AF, are you sure yours is persistent? Have you had a 7 day Holter, do you have a Kardia?
For paroxysmal AF, the usual advice is only consider ablation if lifestyle changes, and if necessary, a trial of rhythm control medication, have not eliminated symptoms.
My impression is that ablation for longstanding persistent AF is relatively unusual in the UK, perhaps because of the lesser prospect of success.
At 52 with a history of TIA, it seems a more nuanced decision. I developed permanent AF/AFL last year at 69 and am considering a 3rd ablation. I am active but struggle to keep up with my teenage kids.
At your age, and knowing what I know now, I would not have hesitated to have an ablation, but I would be very careful in selecting my EP and Cath Lab.
I had my ablation at age 49, best thing I have ever done.
I would do it again if/when I need to
That is amazing, it just terrifies me. I can only think it is because I haven't had a frightening event, and because my symptoms are managed by medication that I am starting to think I can live with this.
If you are confident in your EP there really is nothing to worry about. It’s a routine procedure and low risk. I have had two ablations. They were both painless with a mild sore throat for a few days after the second one (a consequence of the TOE).
It’s your decision, but I decided that I didn’t want to start on the road of medications for life at the age of 64 if I could avoid it.
On a personal level it took 2 PVI ablations, 2 flutter ablations and a 5th ablation which was a combination of both to reduce the intensity of, or increase intervals between, PAF episodes.
Congratulations on your weight loss. if the cardioversion did not work you are in a difficult position as a successful cardioversion is usually the fore runner for an ablation.
As always it is a risk versus reward situation if your ablation is proposed for a part of the heart that is easy to get at, the risk level is low. If it is in another part of the heart that is difficult to get at and close to the phrenic nerve, the damage risk factor can rise to approx. 30%.
At 52 years you are a mere juvenile and time is on your side. I had my ablation done at 70. If you can lose another 3 stone you might want have a fresh evaluation.
if you have already had a mild stroke you really need to take anti coagulants as a preventative measure. It is the one medicine I take without a backward glance.
Thank you so much for you reply. I presume it is the left atrium they would be ablating. I have been under great pressure the last week trying to decide whether to go ahead with ablation because I felt I had to get it done sooner rather than later - was even considering paying privately to get done in weeks rather than months. So hard, I hope I will not regret it but interesting you think I could still get ablation later.
If you are reasonably stable on meds, I would make every effort to loose that other 3 stone with the incentive that the lower weight and other lifestyle changes could make a big difference and anyway will put you in much better shape for an ablation later if needed. I have used the threat of AF coming back to 'force me' into making those difficult lifestyle choices and loose the bad habits. Very good for avoiding other chronic issues later. Good luck and remember which ever route you choose, no one will ever know whether it was the right choice, so at the end of the day it is a personal decision taken individually.
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