Looking for advice re getting an ablation now

[Jmc43]

I have had Afib now since late December of 2017. My first episode was diagnosed and treated at the emergency room, and I was brought back into sinus rhythm and went home with all the proper educational materials. I joined this forum in the next few months and have found it to be an invaluable resource. Anyway, I didn't have another episode until April of 2018. In this case, it extended for a couple of days, and I underwent a cardioversion with my electrocardiologist and it worked fine. I was then prescribed Flecainide (50mg/2x a day) and it worked very well.

Fast forward to early March of this year, and I had my third episode and was converted in the ER the same day. I should add that I am aware of when I have Afib episodes, and wore a monitor for thirty days last year to confirm this.

Since then my electrocardiologist recommends that I now get an ablation, as he says that once flecainide doesn’t work so well, and you have more episodes, the ablation becomes less effective.

So, I have two questions:

1. For those of you that have had ablations or studied them, does that align with your experience? Is one episode in the two years sufficient for the cardiologist to make that recommendation?

2. In this time of Covid19, would having an ablation be more risky given the stress that it puts on your heart?

I realize that people on the forum are not usually medical experts but I always find the sharing of experiences and/or perspectives to be very valuable.

[BobD Volunteer]

I can only speak from my experience here in England but yes AF does beget AF so the more you have the more you are likely to get. That said I don't think that three events really warrants intervention at this stage unless all life style changes have been made . By this I mean the recommended weight loss (BMI lower then 26), reduced stress, no alcohol or caffeine etc. reduction of meat content of diet and less processed foods with a move to a more plant based diet, all of which have been found to be as effective for many people as ablation.

I am a great fan of ablation having had four but one must accept that it is not a cure but merely another way of removing symptoms and may have to be repeated . It is not without risk and one needs total confidence in your electrophysiologist who should have a long and successfull track record in the procedure. Here in UK where doctors are not paid by procedure independence of opinion and advice is guaranteed.

[Hidden]

Purely a personal view Jmc43

1. I’m assuming you are from the USA where treatment can sometimes seem to be driven by financial considerations (well that’s how it appears to some of us Brits) but that said, many EP’s here express the view that the sooner you have an ablation the better. Like BobD, I too am pro ablation but I also agree that it would be a good idea, if necessary, to make any lifestyle changes necessary because these really can make the difference.

2. I was due to have an ablation around June this year but it has been delayed, partly due to Covid19 and to be honest, I’m not sorry. Have had an ablation, I was not so worried about the procedure but the thought of being in an hospital environment for almost 2 day did not excite me.....good luck with you decision making.......

[Jmc43 in reply to Hidden]

Thank you to both BobD and Flapjack for your very helpful responses. I am in the US, so I did try to weigh whether or not financial considerations influenced the recommendation for an ablation at this point. While finance may be somewhat of a factor, it is probably not too large as the facility is a smallish, well regarded community owned, non-profit hospital. If anything, it may be that the physician is an electrocardiologist who has done a lot of ablations and believes in them.

I found it encouraging that you both support ablations, and that you reinforce the point about the impact of increasing Afib episodes. I should have mentioned that between 2017 and now, I did many of the lifestyle changes, the biggest of which was losing weight (a little over 10% of my body weight). I think that helped limit things to one episode in two years.

Anyway, I think I will go ahead with the ablation but postpone it til late June or July for the same reasons that Flapjack mentions. I also have an appointment with my ‘regular’ cardiologist tomorrow, and I would like to ask for his advice but I am not sure how candid the response will be given professional courtesies.

Again, thanks much for your replies!

[Hidden in reply to Jmc43]

Thanks for your kind response, it’s always good to know our efforts are appreciated! There are two AF Association factsheets about preparing for and recovering from an ablation which you might find interesting. They are written by patients for patients and try to cover the things doctors often don’t tell you, just click on the two links below and please let BobD or me know how you get on......best of luck.

heartrhythmalliance.org/res...

heartrhythmalliance.org/res...

[Jmc43 in reply to Hidden]

Great. And thanks for sharing these two very good resources.

[Madscientist16]

I am in the US and I had an ablation about a year and a half after I was diagnosed. I continued to have episodes even with medication and I asked my EP for the ablation. I am 53, active and at a healthy weight with no others health issues except that AF runs in my family. I am now six months post-ablation and am so glad I did it. I am not on any more medication and have not had anymore episodes and hope I will not for a long time. I would go for it, but perhaps wait until the coronavirus issues have mostly passed.

[Jmc43]

Thanks for this reply, very helpful. Just this morning, I consulted with my regular cardiologist for my annual visit, and he supported the idea of an ablation. And he too noted that I would most likely be able to go off flecainide after the ablation and just uses it as a PIP. So thanks for bringing up the medication reminder. I will probably delay it a bit, perhaps to late June. Again, appreciate your thoughts.