Imminent ablation

[Bellaheart]

Got the date for my ablation in two weeks time. I am now terrified wondering if I have made the right decision. It’s the death risk of 1 in 1000 that really bothers me. My af is well under control with only one , very debilitating episode and the odd hour each year. I have been on quite a high dose of sotalol, tolerated well for about 15 years. But I hate taking it and worry about long term affects. I’m fit, 67 and do the 7 minute cardio workout every day which I think helps. The EP thought it was a good idea when I saw her in June last year. Glasgow, Dr Marshall.

[Hidden]

Ive not had an ablation, so am hesitant to comment. My understanding is that ablations( or any a fib treatment) is about quality of life. Ive not had any a fib in almost 2 yr. It started out with debilitating episodes every few months but has become less and less. Personally, a fib is not an issue in my life so I wont pursue an ablation. If it changed and got alot worse, I would reconsider. Ablations are not curative although I know people who have had no issues or a fib after their ablations. It really is a personal decision.

[bantam12]

I'm on the wait list for ablation but after seeing my Cardio this week I'm cancelling it, my concerns were the risk of it not working and having to have it done again however many times, neither my Cardio or EP were confident it would help with my symptoms so that was enough for me to say no.

[Gunnersawus in reply to bantam12]

Do you have persistent AF or AF episodes from time to time? I’m on the waiting list for Ablation and have persistent AF with very few symptoms and sometimes worry about going ahead with the Ablation as my QOL is pretty good really.

[bantam12 in reply to Gunnersawus]

I have brady, tachy PAF with pauses, very symptomatic, last monitor showed lots of AF but not lasting long. I wasn't happy going ahead with the ablation when it's a procedure that may not work and could possibly make things worse. Difficult decision for you to make, good luck.

[cuore in reply to Gunnersawus]

How many months persistent are you? The longer you are in persistent, the more your heart is being remodeled. At one year, the condition is called long-standing persistent. After that time period, it is a matter of time before you will never be able to return to sinus. So, when in persistent, it is not a matter of just QOL as some tend to emphasize but also whether you want to return to sinus or not. It is guaranteed that when in persistent, you will reach a time-line when you cannot return to sinus. Obviously, the choice is yours.

[Gunnersawus in reply to cuore]

Hi Cuore

I’ve been persistent since August 2017 and since then have had 2 CV’s which put me back in NSR for about 4 or 5 days each time. I have heard that the longer you are in persistent AF the more unlikely it is that Ablation will be successful or at least 2 or 3 attempts will be required. My CHADS score is zero and I have no symptoms apart from breathlessness when climbing stairs, but I can do 40 to 50 mile cycle rides every week still. I think the breathlessness on the stairs could be down to Bisoporol which I am hoping to change soon. Put it this way I didn’t get so breathless before I discovered I had AF and went on this medication and I reckon I had AF a good few months before I accidentally found out. So I’ll have to decide on to ablate it not pretty soon!

[cuore in reply to Gunnersawus]

If your CHADS score is zero, you must be young with no comorbidity . I am amazed that you have been persistent for over two years. I am much older than you with high blood pressure. I have had a total of three ablations having been persistent for 6 months for the first ablation. I was told after the third ablation that I was one of the most complicated cases at the 6 month persistent stage and if I had not had it at that point I would never have been able to return to sinus.

You might want to read Dr. Michael Haissguerre (inventor of modern ablation) papers. For example:

afsymposium.com/library/201...

I cannot help but wonder if your symptoms would worsen as time goes by and if you would ever be able to be brought back to sinus if you wait longer ( in comparison to my case.)

I think you're lucky to still be offered an ablation so late in the game.

[Bellaheart in reply to cuore]

I have PAF, rarely too. Just want to be med free and worried it will get more frequent eventually.

[cuore in reply to Bellaheart]

I am not a medic, but I would offer that you need not be worried since your PAF episodes are "rare." It is when one becomes persistent that there is a great cause for concern. It's a long road from rare to persistent.

Perhaps you could discuss with your EP about being med free as your episodes are rare. I would bet that there are a great many that do not progress to persistent. Many factors are involved such as age, comorbidity, life-style, sleep apnea.

I don't know who started you on meds, but GPs ,emergency doctors, and cardiologists are trigger happy for meds. My sister-in-law had an episode whereby she went to emergency. She was prescribed meds - a rate control she did not take. Her EP said she had made the right decision considering the circumstance. About two year later, she is not having episodes and she is not on meds.

By NO means am I saying do not take the meds prescribed. What I am saying is have a thorough discussion with your EP about where you are at in your AF journey with specifics about meds.

[Truckerclark]

I had an ablation at Glasgow royal in 2005 , age 45 , it got rid of my atrial flutter ,but not my atrial fibrillation , I’ve been on meds ever since ,now at the age of 59 ,work terminated due to ill health ( truck driver ) , I’m now possibly looking at pacemaker as mines is not controlled well anymore after having stents fitted 6 months ago ,,,, I’d say don’t get it done if fibrillation isn’t a big issue ,,, leave it till it’s necessary,your consultant should advise this too ,

[bantam12 in reply to Truckerclark]

I have chosen a pacemaker instead of the ablation because it should solve my problems with tachy, brady and ectopics.

[Truckerclark in reply to bantam12]

If it. Ones down to another ablation or pacemaker I’ll go for the latter too

[UScore]

My ablation was amazing. Really easy, the doctors and nurses were good and the drugs were beautiful. And it's halted my AF for years. I don't hesitate to recommend it. Best decision I ever made.

[Hidden in reply to UScore]

Thats good news I love to hear⭐️

[Lilypocket in reply to UScore]

Hi

Where do you live?

Great news indeed which may help waverers. Of course I know it's a lottery but it's nice to hear a " Happy ever after" where AF is concerned! Long may it last for you!

[UScore in reply to Lilypocket]

Bristol, UK. I was 41 at the time, had "only" had about 6 episodes of AF, which were all spread out over about a year. Haven't had any since the ablation, it was 2 years ago now.

I'm not saying "Happy ever after". It's happy so far. If it comes back I'll not hesitate to have another ablation, assuming they'll give me one.

[Hidden]

The death risk should not be anything like 1 in 100 unless you have some other condition/s which make it much more risky for you. The risk of death is about 1 in 500. Stroke risk is about 1/200. Risk of a significant complication is about 5-7%.

[Hidden]

Sorry, misread. You said 1 in 1000 not 1 in 100.

[Fazerboy]

I delayed having an ablation for svt but eventually decided to go for it. That was in Oct 19. Nothing to it really apart from I was told that there was a 1 in 100 chance that I’d need a pacemaker. I took the risk. All ok since but I admit ablating to stop svt is easier than trying to stop af. I was told that I’d know myself when the time was right. Not something to rush into if you aren’t sure. Only you know how it is affecting your quality of life at the moment.

[KMRobbo]

Had an ablation two years ago in two weeks time: AF cryo left atria, followed by an RF flutter ablation right atria one month later, off all drugs since May 15 2018. I was 55 at the time. No AF or flutter since. Get ectopics which I mostly ignore successfully. Sometimes I get long runs which are difficult to ignore and worry me that af might be coming back. However I am perfectly well even when i have them and so far, no known afib! I cannot say the situation will remain like this and AF will never return , but if it did tomorrow morning , I would happily have another ablation tomorrow afternoon, in order to keep off the drugs!

I do not know where the stats come from, but suspect the people who have had the serious issues included within them have other co morbitities, which have contributed to this. I am not medically trained, but suggest If you are worried that you discuss the stats with your EP. He/she will have assessed you and am sure will believe the proposed ablation will be successful or he / she would not be proposing this. The second thing you need to know is that your EP is experienced and succesful so you can believe what you are being told. Then you can make a more informed decision.

You have to be told the risks, as when you have the procedure you will have to sign the consent form which will state the risks you have been told and you must agree to them . It will be a legal requirement. Again I don't know but probably expect this is some UK wide standard text everyone has to agree to as the figures sound like the ones I was given.!

You could ask your EP what his / her state are ( I did not but I was confident in him anyway!.)

Best wishes with whatever decision you take.