I think you are right that your EP would not offer you another ablation unless he/she felt it was worth all the effort.

There is enough demand on our NHS without procedures being carried out unnecessarily.

I don’t think it is necessarily essential tobe prescribed Ameodarone after an ablation. I have had 7 ablations and have never been prescribed Ameodarone after any of them.

The rhythm medication of choice at my hospital (a centre of cardiology excellent) is Flecainide.

Pete

Go with your gut. I’m facing a similar situation except I am having occasional episodes after my second ablation. My EP has said I should go for a third and agrees that I should us the waiting time to assess the situation. If I was in persistent, I would have no doubts, but that is a personal view and we are all different......good luck

I have had 2 ablutions, the first was in 2016 and the second one this past March. The first one lasted about 4 months before I had an afib episode. I have had 2 very short episodes this time (5-10 seconds each) and some pvcs here and there. If I was told I needed a third one and I was in relatively good health I would do it. You and all those who suffer from AFIB are in my prayers

I think I would get a second opinion. As I understand it, the chances of an ablation being successful are very much lower if you are in permanent AF. I wonder why you have not had a cardioversion this time - 10 months seems a long time to be in AF with no intervention? Then there is the question of the Amiodarone.....In your shoes I would be thinking about pace and ablate because saying you are suitable for an ablation is not the same as saying a successful ablation! Naturally an EP is going to think his favoured method of 'fixing AF' is the best but I sometimes wonder if it is in the same league as 'getting Brexit done', ie just an ongoing process. I wouldn't want to do nothing but I'd want to be absolutely certain that the third ablation would be successful and final. Sorry if that seems negative but I thought the suggestion of a third option might be helpful 💜

Also see my reply to Pete 🙁

i was in permanent A F, had 3 cardiovertions, 2 Ablations and still in A F and still on Amiodarone, But had to come off Amiodarone as it damaged my Thyroid,

Was put on 20 mil of Sotalol and had a 3rd Ablation 9 months ago and it worked still in NSR.

So i would go for the 3rd,

Good luck, let us know how you get on if you go for it

Hi I have had 4 cardio versions, none lasted more than a few hours. I have had 2 ablations the second about 4 years ago. I still take 3 doses of flecanide a day and if I ever forget one the AF returns within a few hours, this is very infrequent of course as I rarely forget but it is clear that AF remains a risk without the medication but the ablations have clearly done enough to allow the drugs to control what remains. I also take Bisoprolol. I have never had the medication you mention. I use a Withings watch with an ECG function and as soon as I feel unwell I take an ECG this provides a lot of comfort in understanding what is going on both in and out of AF. My surgeon at Papworth has said he may recommend me having a 3rd ablation at some point if the drugs stop being completely effective or he feels the mapping techniques they use to identify the target areas improve sufficiently - I will have no hesitation taking his advice. Between my first and second ablation I did have a second opinion from a surgeon who uses the cryo procedure as an alternative and he said he thought that ablation was more appropriate for me. If I were you I would have the 3rd ablation. In terms of the recovery. I was also surprised how long it took to recover from my ablation but my surgeon said you need to think about an ablation as major heart surgery just without the added very serious open chest surgery so the recovery is longer than most people expect.

I have had three ablations, and am now in sinus rhythm, 6 months after my third.

I was placed on Amiodarone both after the first and second ablation. After the second ablation , I did ask for another drug since I was having too many side effects with Amiodarone so I was put on Flecanide.

When I went into persistent AF after my second ablation, my EP said, " Let me know when you are ready for the third," "you are too young ( at 76) for pace and ablate, " and "we know that drugs will hardly fix the problem."

For six months now I have felt great being in sinus rhythm. Also, I paid for all three ablations, and glad to have done so.

I am also in permanent afib.... I take Diltiazen prescribed for rate not rhythm and pradaxa. I was told there is no point to have an ablation as the success rate is so low.

I can walk without being out of breathe and can swim laps...... it sometimes sounds to

me it is the drugs people are on that is more the problem than the a-fib.

I also take Hawthorne.....I am 68 and most of the time I don’t remember I have it.....I don’t have episodes as always have it apparently.

Maybe follow your intuition and see what other drugs are possible.....

Good luck

Some really interesting comments there. I’ve had one cardioversion and two ablations. The last one only lasted about 6 weeks unfortunately. I’m only on Apixaban; haven’t been offered or asked for anything else so will investigate that further. I do wonder if I’d had been taking something whether that would have helped on the day my heart went wild after the op. Waiting to see EP and hoping he’ll agree to another ablation. The difference a successful ablation makes to how one feels is amazing.

I've had 2 Ablations the 2nd one lasted only 10 days, as a result my heart rate soared to 150+ with the same symptoms you describe. My consultant has stabilised heart rate with Bisoprol10mg and Digoxin but still in AF I have the option of a 3rd Ablation but I'm being advised my heart is now scarred as a result of the laser activity, you may wish to query this?

Hi, the 10mg of Bisoprolol is a pretty hefty dose, and I could barely function when I was on that level and a complete zombie on 12.5mg/day.

However, AF is progressive so if I was in your situation I would be grabbing that ablation asap.

As for Amiodorone, I took it for 6 or 7 months following my first cardioversion, it damaged my thyroid as well as some other nasty side effects. I did not take it after my ablation 2.5 years ago.

I know that I prefer to be drug free, and for now my ablation has ensured that has happened

Hi as you are on your 3rd ablation I would ask if there is any chance of being considered for the AcQ Map trial which I think is targeted at the more complex persistent cases.

Andy

Been in persistent AF since February 2018. Had 2 cardio versions. One lasted 3 days, the other 5 days. Had first Cryo Ablation with sedation 26 September 2019, didn’t put me in NSR at all. Tbf, consultant said would probably need a follow up CV for that to happen. That booked for 16 December so everything crossed for a NSR Xmas and New Year. Only on Rivaroxaban, binned the Bisopropol, made me so lethargic. I keep myself in shape so recovery has been quite ok. Back to small runs and swims. Lots of dog walking. Can play golf again. If the CV doesn’t work would have no hesitation another ablation. Interestingly the consultant said I would be prime for a hybrid ablation. That would be more onerous but much better success rate. Good luck to all sufferers with their decisions.

It’s really horrible feeling so rubbish and out of breath on exertion.....I hope that you get the answers that you need. I was only diagnosed last year after planned ablation for SVT showed up AF issues, I felt fantastic for 4 months after Cardioversion, and was just so relieved to finally get correct diagnosis..

Just an idea, are you able to swim or exercise in water at all ? Its a lifesaver for me , helps so much to boost my circulation & improve fitness levels.

If you can, give this a try:

------------------------------

After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??

I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.

Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer

PS – there is a study backing up this data you can view at:

https//www.cardiab.biomedcentral.com/articles/10.1186/1475-2840-7-28

And Oh - if you find that your sugar threshold is lower than 50 grams a day - and it's nearly impossible to eat less than that each day, which will keep you in permanent Afib. If this is the case, try going to a Nutrition Response Tester. I am doing this and she has increased my sugar threshold from 48 grams a day to about 75, which is high enough to stay under - and keep afib from happening (unless I indulge in a sweet something). Hope this helps.

Thanks very much, I do try to keep sugar to a bare minimum as I am pre diabetic. An interesting theory though as I know I feel so bad if even a little dehydrated.

Wow! So much info, I was interested as I had 1st ablation in July. I'm only 42 and have been diagnosed since I was 39 originally with paroxysmal Afib but before ablation, since last year, I'm now in persistent AF. My ablation didn't work, as monitor in September showed.

To boot I have LOW BP (90/60) and high heart rate (approx 140) despite being on 7.5mg of bisoprodol and just recently meds changed to Amiodarone to help with HR. (was on 167mg Degoxin from January-October / and flecanide before THAT!)

Consultant has booked me in for cardioversion BUT on the day I go, if I'm in sinus rhythm then cardioversion won't need to be done, and also planning to do 2nd ablation in new year. I'm happy with my treatment and EP consultant is well renowned at NHS hospital. I've been told I'm too young to suffer from it and they don't want a life on drugs, IF they can make it calm down... Fingers crossed. Hope yours works out too, I'm hoping I won't need a 3rd ablation!