What makes people decide to have ablation? Would you consider it if you had no symptoms during episodes and managed to self convert?
Ablation : What makes people decide to... - Atrial Fibrillati...
Ablation
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Lindaj754
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It depends on how the AF attacks leave you feeling. Mine would make me tired for days afterwards and would strike every 4-6 weeks without fail. How often are your attacks, how long do they last, what rate would your heart go up to and do they leave you feeling drained?
I wouldn't consider an ablation (have had three) unless AF attacks were quite severe, but some people say the earlier you have one, the better the success rate.
Jean
Thank you
BobDVolunteer
If you are largely asymptomatic there is no point in having an ablation for AF. Any and all treatment is only ever for symptom control and quality of life (QOL). If your rate is well controlled at all times to prevent over working your heart then that is all you need to worry about. Plus anticoagulation for stroke prevention of course.
Linda, that is a massively difficult question to answer for a variety of different reasons. Whilst an ablation(s) can be very successful at helping to control symptoms, they are not a cure for AF and there are associated risks, but they are generally small. If you are asymptomatic and AF is well controlled with medication then many medics, particularly in the U.K. are less likely to recommend an ablation. There are also a wide variety of lifestyle changes which some can make which can have an enormous impact on reducing episodes of AF. On the other hand, AF tends to be a progressive condition, episodes can become longer, possibly more intense and may even become persistent, ultimately permanent. However, once permanent patients can adapt quite well with medication and go on to lead relatively normal and long lives but others are reluctant to take fairly potent medication for the rest of their lives and therefore opt to take the ablation route, even though there are no guarantees. Jean is absolutely right when she says that many EP’s recommend early intervention because AF has had less opportunity to change the structure of the heart which tends to make ablations more successful.
Personally, I am pro ablation. I have had two and they have made significant improvements on my quality of life and I would not hesitate to have a third should it be deemed necessary but we are all different. It does sound as if you are doing well, so maybe things should stay as they are for the time being.
I suggest you take a look at the pinned post for Newbies and Oldies to the right of this page where you will find a lot of helpful information about having an ablation .....hope this helps.
Rubymurray25 in reply to
"Personally, I am pro ablation. I have had two and they have made significant improvements on my quality of life and I would not hesitate to have a third should it be deemed necessary but we are all different. It does sound as if you are doing well, so maybe things should stay as they are for the time being."
I found your words as above very reassuring as I was told on Friday I need a third as the two last year haven't conquered the issues, but would like to think it has shown the Cardiologist and better insight to my particular flaws. For me it is a simple matter of trusting the experts as they can see how different we all are, so fingers crossed 3rd time lucky!
in reply to Rubymurray25
I agree with you too. I think we should accept that EP’s will only perform an ablation if they are reasonably confident the patient will benefit. With waiting lists as long as they are, they clearly are not short of work!
Good luck.....🤞🤞🤞
ETFCfan in reply to
That’s exactly what I figure. I’ve thought long and hard about having a third ablation and was put on the list at the end of February. I’m in persistent AF and suffering quite badly with breathlessness and fatigue but can function. I came to the conclusion that myEP is not going to waste his time and NHS resources if he doesn’t think it’s worth a go. Nice that you agree.
Lindaj754 in reply to
Thanks for this
Salvatore68 in reply to
Where is the info , the pinned post for Newbies and Oldies? to the right of this page ?
in reply to Salvatore68
It may not be easily accessible on smart phones due to screen size but on iPads an PC’s they feature literally to the right of these posts from the top of the page. There are 3 groups, first is “Related Posts” second is “Supporting the Community “ and then there are the “Pinned Posts”
MargaretWendy in reply to
The other answer rather than rushing into an ablation is to have a better diet - eat everything that is easy on the digestion to cope with - get advice from my and my daughter's nutritionist, June Butlin - in the
Bristol area - on the web
in reply to MargaretWendy
Hence the reference to making lifestyle changes
If you ask an EP (electrophysiologist) he will say yes, to nip it in the bud.
If you ask a cardiologist he will say ablations are over rated and should be a last resort if you can’t cope with symptoms/meds.
If you ask a GP he will say AF is a common complaint, take the pills, next please.
If you ask me I say if it ain’t broke don’t try to fix it.
I am joking but that more or less covers various attitudes and it is really up to you 💜
Thanks. This made me laugh and is probably true!
So true! Here in France my cardioligist advises that people live very well on medication with Afib. But my episodes - for the time being frequent but not long and self converting - are very annoying but livable with. I took an appmnt with an EP who advised an ablation while it was not persistant which would give it a better chance of working. Dilemma. I'm fine now but know it will get worse. Decisions, decisions!
I have had this conversation with my EP today,when I was diagnosed with PAF last June I had no symptoms however since the beginning of the year notice the episodes which in the last couple of months have been roughly every three weeks and lasting about 6 to 8 hours it’s the tiredness the next day that gets me,so I have agreed to a Ballon Cryoabulation which I think will be in around three months,I could not get on with the medication,it was a difficult decision to make.
Good for you! Let me know how it goes as your Afib sounds a bit like the stage mine is at. However the EP I saw will only do RF and doesn't care for Cryo as he says if it looks more complicated it can be sorted at the same time to help avoid, where possible of course, another ablation. But I would certainly happily accept a cryro ablation if offered as I have heard good things about it.
Take care and fingers crossed for you.
Good job Buffafly. You succinctly captured the gist. So, the GP can be eliminated because he is not up-to-date. The cardiologist should be avoided because he just wants to hoard you as a patient and eventually get you to permanent. That leaves the EP who will try to get you back in rhythm. If you ask me, I would go with the EP, and I did , and now I am in sinus rhythm. I am not joking but I loved your reply.
No one can advise you on this, right now you probably don't need an ablation and the Docs would likely not recommend one. There is a school of thought that symptoms are likely to get worst and an ablation now would be the best in the long run - but no one knows. My advise would be to let sleeping dogs lay, until they wake and become a nuisance. However EPs know a lot more that I so I would take their advise - unless your paying for it then monitory gain can fly in the face of best medical advice.
Thanks
My EP advised against ablation on the grounds that my AF was pretty asymptomatic, hardly affected my life at all, was well controlled with drugs and had become persistent - and I'm not sure how long it had been around for. I had a cardioversion and hardly noticed when I went back into AF - it was only noticing an irregular heartbeat that made me aware that I was back in AF. NSR lasted a couple of weeks.
Taking all of those things into account (and probably more I'm not aware of), he advised against ablation because ablation entails a small but finite risk and wouldn't really lead to any gains. Five years on, I think he made the right decision. As BobD said, it is all about Quality of Life (QoL) and studies suggest Quantity of Life (Longevity) is not significantly different.
Thank you
I just took the plunge and said “ go ahead” for an ablation and all being well it will be in the next 6-10 weeks . I get an episode 3 time s a month at least , the last was for 11 days ( 11 miserable feeling underpowered and anxious days) in all honesty not debilitating symptoms more like a permanent jet lag . I am trying not to dwell on the procedure which frightens me a lot. And my decision was based on quality of life
The internet has a lot of information on how the procedure is done. There are even videos posted. I suggest you do some research on the procedure to alleviate your being frightened. I've had three. They were a piece of cake. Good luck for yours.
One point though. The definition of persistent AF is beyond 7 days. You went back into sinus after a constant 11 days. That's remarkable.
Thanks for the advice I will do more research I am just not great at filtering it!😀 if I read 100 positive and reassuring posts and 1 negative one .... I tend to focus on the negative one!
By research I do not mean just the Healthunlocked posts. I mean go to the address bar for the internet and type in "cardiac ablation procedures. " There are several articles and videos that you can view.
I did that and my address bar came up with :
google.com/search?q=cardiac...
Let me know if you still need some tweaking.
I tend to fall on the side of the naysayers in your particular case. It’s an option but if you have no symptoms and no signs of AF doing damage, which I am imagining you have been screened for (echocardiogram or MRI?) then why undergo a procedure which may take some time to recover from and run risks, albeit very small risk, of complications.
I think it is a personal decision and factors such as age, how AF impacts on your life, other conditions and skill, expertise and advice of your clinicians will all need to be considered.
My only proviso would be for you to be aware that ablation is more likely to be successful longer term, if performed early in the process. Should your AF episodes become more frequent, which often happens, I would be alert to the possibility of AF being progressive and reconsider.
This is written retrospectively - I would try everything I could re: Lifestyle to avoid further episode and medications, other than anti-coagulation and any invasive procedures.
Thank you for this
Hi Linda, you already have some excellent advice from the replies. I would add one point, equally important IMHO, namely you should include your general state of health in your decision. If you are fit, healthy & boosted with a few supplements without any chronic disease then I think most medics would agree there is less chance of issues with an ablation. However, I still agree with the view only go for an ablation if your QOL dictates it; in that situation you won't need to come here for information to make your decision!
I had mine early March and it has changed my life for the better. I'm still recovering as I tire easily but I'm running again and hope to resume super long walks after lockdown. I had SVT which would kick off for no reason or when stressed. I'm hoping that the DVLA send my driving licence back soon. Good luck.
Surprised your licence was taken away. I would regularly drive with PAF although I never set off with it.
If you read the medical requirements you must surrender your licence. My GP told me and cited the case of the bus driver in Glasgow who killed people when he crashed into the station s few years ago. As my SVT made me pass out it's not surprising!
If you have no symptoms how would you even know you were in AF, let alone that you had self converted?
I had my ablation 2 and half years ago and have no regrets. I didn't have many episodes of AF, but they were pretty uncomfortable. Have barely had an ectopic beat since then. If it comes back, and the docs let me, I won't hestitate to have another.
I always advocate for ablations. Afib begets afib. The sooner you take care of it the greater chance of success.
In my case I had episodes of AF every 6 weeks which lasted about 2 hours. I recognised when they started and when they stopped. That was 20 years ago. Zoom forward to 2018 and I had been on medication for 3 years but AF episodes were twice a week lasting at least 24 hours. My cardiologist said " I am just the plumber but you would be a good candidate for an ablation". EP organised an ablation within 3 months in late 2018. Good result. Much better quality of life.Never looked back. But I wouldn't take anything for granted. AF affects everyone differently. Good luck.
When all you can do is watch TV for 3 days out of 7 and customers reach to dial 999 when PAF kicks in. It comes down to quality of life...... At any age.
Hi, I went down the ablation route as I’m young and in the very early stages of AF.
My EP suggested it was a good option to resolve before it progresses. I had private healthcare too which made the process easy and fast.
If it doesn’t work, I’ve got the choice of having again or manage the condition with medication.
Ablation recovery is no picnic, I’m nearly 6 months post op and still not fully there yet.
I’m not sure what I’d do if I had no symptoms, I guess I’d rely on a trusted EP to help make that decision. I’ve had 2 ablations and it seems they’ve mostly taken care of the AF. But I still have SVT. EP who did the ablations basically turned his back on me at that point. Found a new EP who actually listens and offers sensible advice. Was supposed to have that 3rd ablation, but Covid cancelled non-urgent surgeries. Hoping this fixes things, meds make feel awful.
My father was controlled nicely by a medication until they took it off the market. It had taken a long time for him to find a medication that worked. As he was living in France at the time his U.S. cardiologist suggested a ablation which he did. His boss retired him no doubt after receiving the bill (they kept him in the hospital in France to rest afterwards one week). My father was two weeks shy of 80 when retired.
My father made a mistake years afterward by going off his blood thinner. Given his fast paced lifestyle this adversely affected his health. I think he occasionally went in & out of AF as he neared his 90s, & is memory then suffered.
It just seems like so many factors play into one’s treatment decision such as lifestyle, drinking habits, proximity to competent healthcare, lack of success with other measures, etc.
Flapjack gave excellent advice, and JJHRT gave the reality succinctly. The trick is not to get to the persistent stage (episode lasting longer than 7 consecutive days). In persistent your heart becomes fibrotic and gets remodelled. That is the period that real damage is done to the heart.
To help you with your decision which may take you beyond just quality of life, you may want to read about these two trials:
Rocket AF trial
ATTEST trial
As others have written, it depends on any symptoms. I have had permanent AF for two years without any symptoms. On the advice of a cardiologist, I take no medication and am not going to have an Ablation.
There are negative consequences of medication or ablations. My understanding of an ablation is that you are burning (i.e. killing) bits of your heart. The aim is to kill the bit that isn't working properly any more. Sometimes the process has to be repeated several times until they get the right bit. And even then there is evidence that an ablation is only temporary -- the problem comes back although it may be several years later .
So you should ask if the benefits outweigh the risks and consequences. If you have distressing symptoms then a process which restores normality for several years is a massive plus. But if you don't then why bother?
I live a great life with my permanent AF (I cycled around 150 miles last week for example) so for some it is possible -- it depends on the condition of your whole heart, not just the pace-setting bit. My resting pulse is the same as it always was -- it is just that now it is irregular.
Doing nothing is often a very good choice don't be afraid to take that choice.
I had self limiting AF for 10 years. Two hours an episode. It left me tired but not very tired. That was before GPs talked about the risks. It was all "don't worry dear " and take an aspirin. I had not even heard of ablation.
Roll on to 2016 and AF became persistent. Having it night and day was very scary. It made me breathless, panicky, agoraphobic. Then I started researching. How I wish I had known 15 years ago what I know now!
So, you asked how do people decide to go for an ablation or not? Well, I did a bit of risk comparison. Members have already said that AF is progressive - it gets worse. And persistent AF is harder to treat. It enlarges your atria . I am risk averse so I compared the risks of persistent AF - damage to my heart, mental state, QOL etc - with the risks of having an Ablation. But on balance I decided an ablation was worth the risk.
I have not regretted it. I am not completely cured but am in sinus rhythm 99% of the time. That to me has been a success. It took time to recover from the procedures, the first few months after the second ablation were difficult as the AF was worse for a bit. But suddenly things improved and since then - 3 years on- I feel so much better.
Things will become clear for you I think as time goes by. If AF is not bothering you much and you are happy with the risks of not treating it with an Ablation, that's ok. But do some research.
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