To ablate or not...

[Flutter-1]

I'll try to make this short... ish

48 years old, fit cyclist. Diagnosed 3 years ago with paroxysmal AF. Had a cryo balloon ablation in June 18. Felt dreadful afterwards and episodes became more regular towards the end of the year. Had a second RF ablation in January 2019. Much more comfortable afterwards. But after 5 months episodes became fairly regular at fortnightly intervals. I had gradually weaned myself off daily bisoprolol and flecinide in the months after the second op. This meant that when I then took these as a pill in the pocket AF episodes usually stopped after about 3 hours, at this stage.

I saw the cardiologist in November and he recommended a final ablation as there was probably a reconnection that just needed finishing off. It makes sense as I'm young (his words, this context!) and fit and we've come this far.

All good, still with me? I have this 3rd ablation scheduled for end of March. The thing is I've not had an episode since I saw the cardiologist. 3 whole months. Before Christmas the episodes were often triggered by bending over. The cardiologists looked at me like I was crazy when I said this but that is how it happened. I have a Kardia and obviously I have felt little flutters and things but I know when 'I'm out' and the Kardi confirms it, or settles my mind if I'm not sure,

I appreciate that no one on here is going to say get the ablation or not. But my question (if you're still reading) is whether any one has knowledge of AF disappearing 9 months after an ablation rather than in the normal blanking period? I would be very interested in hearing similar experiences.

Obviously there is risk to me and expense (to the wonderful NHS) in having another procedure. Whereas if I don't have it now I go off of all the waiting and care lists. Would it be wise to have the final ablation before things get worse?

My inclination is that it is currently managable so maybe I should cancel the op.

Big decision...

[BobD Volunteer]

As we say in our fact sheet on recovery three to six months for full recovery and many people are still improving at nine months. I think rest and not overdoing things whilst mainting a (not too strenuous) exercise regime is important during that period.

[Buffafly]

Bearing in mind coronaviris pressures I wonder if you could not opt for delay rather than cancellation? If the AF returns it would seem sensible to have a 'touch-up' but great if not. I am sure I have read posts saying all came good after nine months.

Re the bending over, my Tai Chi instructor said that anyone with a heart condition should not bend down too far. My AF is often brought on by stretching up including swimming front crawl! not always immediately but definitely a link within 24 hours. I am guessing pressure on heart/vagus nerve or lungs.

My friend quoted her mother who said 'Now that I'm middle aged.....' She was 70 and lived to 100. So 48 young by today's standards, best wishes 💜

[Flutter-1]

You know the strange thing is I've been very pressurized at work. I hesitate to say stressed because it is good work - just lots of it and pressure.

Also I now have the odd drink - very much in moderation. Whereas I had nothing for 4 months after the second ablation. I eat healthy but am not immune to the odd slice of cake. Cut out caffeine 2 years ago s coffee and tea taste pretty much the same without it.

Cycle to work everyday (7 miles there and back, pretty flat). Longer ride at the weekend. Couple of trips to the gym a week. In fact, if I don't exercise I can feel things getting a bit jumpy heartwise. Maybe it needs the minor stress of a regular rev increase?

Maybe it really is all about a good balance?

[Fazerboy]

I can't advise as to whether you go for an ablation or not but just for info I had svt which slowly got worse until I had an ablation. My point though is that bending over would trigger the svt. It got crazy in that to tie my shoelaces etc I had to bend my knees and crouch down rather than bending over. I also had to do this if I had to pick anything up off the floor. I also found that if I lay on my back I could get the svt to stop (a sort of reset button). All ok since the ablation.

[Gowers]

After my 1st ablation hr was anything from 80 -180. At my cardio follow-up appointment 2 months later cardiologist made appointment for a 2nd ablation there & then but. Said if I decided to not to go ahead & instead try different medication that would be ok. Just before ablation I was feeling well - no af & was on the point of cancelling. Glad I didn't as once again heart rate & rhythm went haywire - went into flutter & hr around 100. I felt exhausted. It's not an easy decision as we know it isn't always the cure we long for.

[Gincalpe]

As you have a date for another ablation I would go for it but as you cycle daily you need to read the recovery fact sheets and take it easy for a while afterwards to let the heart heal.

[Roto]

consider this,

at present you state your fit and healhty if you were unfortunately diagnosed with another illness and then deemed not fit enough to under go an abalation..and the Af became even more problematic..not a great position to be in,

[Dodie117]

My af took about 5 months to go away after my ablation and almost a year for resting heartbeat to return to normal. In your place, I would ask to postpone for say 3 months and wait and see. As someone else mentioned, you might not want to be near hospitals for the next few weeks until we see how coronovirus behaves.

Good luck.

[cpalmermn]

I’m of similar age and activity level. Must peddle to stay sane. If it were me, I’d probably hold off on the 3rd if episodes had stopped for 3 months. Have you spoken to your EP about this?

I’m just approaching month 3 from my first ablation and things have been pretty quiet so far. Fingers crossed!

[Flutter-1 in reply to cpalmermn]

I spoke to an arrhythmia nurse specialist at the hospital. He was very helpful and said we could discusss it at my pre-op. My concern was I should decide quickly (before the pre-op) so as not to mess the hospital around. He wasn't concerned with this, presumably the surgeon doesn't sit twiddling his thumbs if he only gets a week's notice.

SO this is reassuring as I get another 3 weeks to see how it goes.

Thanks for all the input everyone

[planetiowa]

Regarding the bending over triggering AF, I would probably say that is the trigger for probably 25% of my AF episodes. And even when it doesn’t trigger it, it will occasionally cause my heart to flip flop several times (I kind of compare it to a lawn mower trying to start up but won’t) and I will quickly stand back up and wait for it to pass. Most of the times it does but occasionally it goes into AF.

[Flutter-1]

Well, obviously the decision has been taken out of my hands now anyway. Interestingly, or rather annoyingly, I actually had a 45 minute AF episode - the first in 4 months - the day after my pre-op was originally scheduled. Imagine if I had declined then I would have felt very stupid. When it's back on I'll get the ablation. whenever that will be.

Stay safe everyone. And sane. I think my latest episode may have been linked to anxiety with world events, safety of family and trying to move my business from my studio to home..

[Walkingwallet]

You described my scenario almost perfectly.. Although my AF could be triggered by bending over, turn my body as in to look at something to the side of me, or even by yawning and stretching. I couldn't even sleep laying down because I would experience rhythm increases.

I'm 54. In good physical condition. I run avidly (I train daily when I'm not afraid of AF taking me out) I never drink anything that contains caffeine or artificial sweeteners.

I had a second ablation today in attempt to resolve those symptoms. As of right now (13 hours later), I can say that I have been able to lay flat on my back and sleep for the first time in a year. I've involuntarily yawned and stretched (the motion that put my in the ER with AF in April). So far, so good. No dizziness... No AF ... only the expected short rhythm changes that come with ablation healing. And some crazy eye sprites (but that's off topic here).