Should I have a PVI ablation?

[petcardiac]

I have had PAF occasionally over the past 40 years - am now 63- had a limited ablation in 2010 which improved the situation but did not eradicate all PAF - since going semi retired in 2013 have become a lot more active with sports and some jogging and PAF has generally improved - also any PAF episodes always self corrected within a week or two . Then in March 2017 and very much " out of the blue" had a PAF which lasted 3 months despite two cardioversions - at that time- June 2017 - it was assumed that my condition had deteriorated and that going forward episodes would now be more frequent and longer and I was advised to go on the watiing list for a PVI ablation which I did - at the same time I was put on a revised medication regime which included a rhythm medication (Multaq) for the first time - though the ablation was supposed to take place within a year - ie by June 2018 - owing to some admin issues at the hospital this did not happen - in the meantime however my experience over the past 3 years has in fact been much better than I or the doctors expected and I have had very few instances of AF and they have all self corrected withinn a week or two- however have now received an invite to have the PVI ablation done at the end of the month but should I go ahead ? In the last 3 years I have done lots of sport- tennis/ pickleball etc and had only occasional and limited PAF - the problem with AF is that you never know why an episode starts or stops and how many you are going to have and how bad or long they will be - at the moment having an ablation feels a bit like a "sledgehammer to crack a nut" but I know that as you get older usually episodes become more frequent and serious and that the ablation success rate also declines as you get older - on the other hand any operation has risks and apart from that could the ablation actually mean that I have more AF episodes than now?? I have heard in some cases this happens and that the 3 month period after can also be problematic sometimes - I am not bothered about the operation itself and if the past 3 years had been full of bad AF episodes I would definitely go ahead but as matters stand feel it is a bit of a 50/ 50 call? Know it could mean being AF free for good and all and maybe no more meds (though I have no issues with the meds anyway so that is not a big benefit for me ) Some people who have had an ablation say they "feel better" as well as being AF free - is this the case?? If so how and why? All to do with "risk and reward" and at the moment feels like "tossing a coin" situation - any thoiughts? The experiences of others who may have been in a similar situation woud be much appreciated

[Buffafly]

Hi, I can understand your dilemma which is not unusual at all and if you were taking a 'common' drug then it would be understandable if you held off for now. However I googled Multac because it's not a drug I know and the first thing that came up was that the generic name is dronedarone, not a drug prescribed here, maybe for good reason as there is an FDA warning on it. Here it's big brother Amiodarone is prescribed as a drug of last resort for a short time, often to prepare for cardioversion or ablation. So maybe not something you would be wise to take long term? Hope that helps.

[petcardiac in reply to Buffafly]

Hi Butterfly and thanks for this - Multaq/ dronaderone is used quite widely in the UK and is seen as less toxic - though against this not as "powerful" as compared to amiodarone or flecainide so on that level it is a "mild" and "first stage " anti arrythmic drug and the usual criticism of it is that it is not as effective in maintaining Sinus but it has been fine for me

[Buffafly in reply to petcardiac]

That is very interesting as I had understood it is not available here. Thanks for the info.

[Marytew]

webmd.com/heart-disease/atr...

Hi

This is a very difficult decision for you to make given that you have felt so much better over the last three years. I see that you have put that having an ablation ‘could mean being free of AF for good’ which would appear to indicate that you also realise this is not a certainty. The above link to an article regarding treatment of AF with medication, ablation, or a combination of both, may help (possibly) in coming to a decision. Good luck with whatever you choose to do.