Early ablation - anyone else been offered so quickly?

I have been offered a cryo ablation very early in my PAF journey, in 3 weeks, I was so surprised I asked for them to get back to mE later.

I have posted before, I had two AF episodes 4 years ago, then 4 earlier this year, in June and July which seemed linked to alcohol. I had a lengthy consultation with a youngish well regarded NHS consultant at the beginning of September. He said he thought early ablation very much more successful. He also said to hold off flecainide until a heart scan (scheduled end of October) and not to take Bisoprolol as countersign indicated for those whose triggers are vagal ie depressants.

Am I wrong to wobble and turn down for now? I dread more operations. Although medically fit I have had a torrid orthopaedic journey and some bad outcomes!

[BobD Volunteer]

Your consultant is right in saying early intevention by ablation is best. He sounds on the ball. as AF begets AF and the more you have the more you will get. Likewise beta blockers will likely make things worse if your AFis vagally mediated. It is wonderful that he wants a scan before prescribing flecainide as well since this is often forgotten with possible dire consequences. All in all I would trust this person and take their advice. By the way is is not an operation, rather a procedure performed in a catheter laboratory rather than an operating theatre so far less of a worry.

[Hidden in reply to BobD]

Thank you for your prompt reply which fits with my research but I dread even a “procedure”. It could go wrong!

(An internationally expert surgeon managed to place a hip replacement inaccurately and another inadvertently stretched the femoral nerve when revising it, leaving me in great pain and months of disability).

But i will get back to them after the scan.

I can’t believe how poor the advice I had previously from my GP and the private consultant (also part of the good local NHS team) who I saw during COVID difficulties when GP said my problems were “common” handled in primary care and I wouldn’t be seen for a year.

[Easternmost in reply to BobD]

Hi,

I am having an ablation on Monday for flutter, but was interested in the comment about ‘vagally mediated’ arythmia and Bisoprolol (which I take) - are you able to elaborate a bit more on this please? Thank you.

[BobD Volunteer in reply to Easternmost]

If AFcomes on with low heart rate as is often the case with Vagally mediated e g when sleeping or after meals, then slowing the heart with beta blockers doesn't seem particularly clever.

[Harrison1 in reply to BobD]

Interesting. 4am today...bump...AF kicks in. Always feel pretty useless when it kicks off (I am 45, fit and have lone infrequent AF).

Took 1.25mg of Bisopolol and it’s starting to correct itself but my resting HR us around 45-50....so am cautious taking a beta blocker

Thanks

[Cliff_G in reply to Harrison1]

I suspect (no proof, other than 25 yrs experience!) beta block is mainly contraindicated when you're in sinus rhythm. At slow heart rate, the non-refractory period is much longer and allows a trigger ectopic much more statistical chance to meet the excitable period and kick off AF. Coumel described this clearly that the heart rate slows down further just before AF starts, in VMAF. Once you're in AF, beta block may be useful, even in vagal AF (they're relatively short-acting), like I got post-operatively after an open heart op. But if you convert back to sinus again, beta blockers will make things worse again.

[Harrison1 in reply to Cliff_G]

Cheers

I only take it as a pill in the pocket and a mild dose. It normally helps slow it for and my heart typically tries to correct itself 👍🏻

I do sense change however slowly; as in my condition becoming more frequent which really concerns me

[Cliff_G in reply to Harrison1]

Habe never heard of beta blocker as pill in the pocket, before, good idea though. Yes, I was in denial that my AF was getting worse for years until it got so bad I needed an ablation. For me it used to stay steady for many months then suddenyly step up a bit and get worse, a stepwise progression overall.

[Harrison1 in reply to Cliff_G]

And my view, albeit maybe incorrect, is that is where I am going...

I have a very stressful job which doesn’t help

Thanks

[Cliff_G in reply to Harrison1]

You'll be great. I had mine in 2002 when it was early days (though I did go to Prof. Haissaguerre, so, the very top). I had 15 good years until an aortic dissection in 2017, though I only went into AF a week *after* the op

[Easternmost in reply to BobD]

Interesting - thank you for explaining that, much appreciated.

[Hidden in reply to Easternmost]

Someone gave me an image. It may be a bit crude and perhaps others may know that it is inaccurate, but here goes...

“Vagal triggers make the rhythm stutter. It is like when you stumble running. When you stumble you try to run through it, increase your pace to steady your steps. When your heart rhythm stutters, it tries to right it by increasing the pace. If you take a beta blocker you are addressing the pace not the rhythm, and your heart resists the medications attempt to slow the pace and fights it and strains. The better medication is something that addresses the rhythm like flecainide Paradoxically some find running or intense exercise takes them back into sinus rhythm.

If you have excitement triggers, something triggers a speeding of pace (Stress, exercise, anxieties, caffeine, tiredness etc), and this throws out the rhythm. If you slow the pace the rhythm may correct itself. So calming behaviour helpful.”

I have vagal triggers but a very fast pace once AF kicks in.

[Easternmost in reply to Hidden]

Beautiful explanation, thank you - I definitely fall into the second category!

[Finvola]

It sounds like you have a superb consultant who knows - and practises - best policy regarding AF and its vagal source in your case. Your GP isn't usually the best informed about a complex condition such as AF and may be inclined to generalise.

I can understand your caution, with your dreadful orthopedic experiences and the scarcity of AF episodes in the past. The fact is that your heart is susceptible to AF and that may recur and a cyroablation is nothing like the horrors you have already gone through.

Best wishes with your decision - it sounds like you have the option to keep the offer open which may be better than turning it down completely.

[Buffafly]

If you’re still affected by a disability now is a good time to have an ablation because you have to rest anyway and you won’t be tempted to rush out trying to ‘get your fitness back’.

How did you come by this great EP?

Best wishes 💜

[Hidden in reply to Buffafly]

A retired GP friend has AF and his consultant was also retiring and recommended this one to take over his care. I asked my GP to refer me. I previously saw (privately) an elderly expert who is listed on one of these sites as an expert in AF, he was amiable and also said “if it doesn’t look as though it is going away have an ablation”, but very unhelpful / not detailed about anything else and prescribed flecainide without examination.

[Hidden in reply to Hidden]

Realise I didn’t tell you where- Royal Sussex County Hospital, Brighton UK

[Buffafly in reply to Hidden]

Bit far for me and too late 😥 but hopefully useful for someone else. Nothing like a good personal recommendation. I am trying to get to see my friend’s cardiologist but not sure how that’s going to work.

[Desanthony]

Brilliant service in this case from your consultant. I wish I had

1. Been able to see a consultant at the beginning of my AF journey.

and

2. Had such a good one when I did see one.

It took a move of house before I saw a good NHS cardiologist and then a lot of pushing and a couple of private consultations with an EP (who incidentally was part of that team) to get to my ablation more than 3 years 6 months after my diagnosis. I am thankful that once I had moved house my new cardio organised a cardioversion which was successful as no rate control drugs did anything - beta blockers, calcium blockers etc and bisoprolol fair near shattered me. Thing which annoyed me was that I was in the same health care area and could have been referred to her in the first instance. Still, it is what it is and I am where I am. I am having my ablation next Tuesday Covid allowing.

[Hidden in reply to Desanthony]

Please let us know how it goes!! Good luck

[Desanthony in reply to Hidden]

Thank you. x

[KMRobbo]

I wish I had been offered AND accepted an ablation on day 1. I would have missed a load of hassle!

Like you I would have turned it down. I did not want anyone inside my heart.

2 years later after 12 afib attacks and just being in hospital (again) this time for the best part of 8 days with high rate afib at 130 to 195 resting , and being put onto a more intrusuve drugs regime, I changed my mind!

Afib begets afib! The more you have it the more you will get it.

It took another 9 months after to sort it out with an ablation

Having said all that do NOT do what you do not want to do!

However do weigh up the opportunity versus your current and possible future issues. That may involve another discussion with our EP

Best wishes whatever.

[Dodie117]

My first consultation with EP gave me choice -meds route or ablation. Like you, I wanted to think about it. After a few weeks I asked for a second meeting and then opted for early ablation. That was 2013 and never looked back. It took 5 months for all bumps/arrhythmias to go away but then no more. So very pleased I made that decision. I was very nervous but got there. Good luck 🍀

[Hidden in reply to Dodie117]

5 months!!!

[Dodie117 in reply to Hidden]

Yep. I wasn’t ill or anything but the arrhythmias gradually reduced. It took this long to go away completely and almost a year for resting heart beat to return to norma.

[lwm1198]

My ablation was scheduled after being in Afib at the second meeting with my specialist, and then showed several episodes a day while wearing the monitor. I later realized I'd been having PAfib for a few years and hadn't known! Procedure was day surgery, and although I experienced some unexpected but not unknown side effects in the following days I'm two years out and feeling great!

[Cliff_G]

Great advice from your doctors, wish I had had this when I started years back, had to find out for myself the hard way. Dr Sanjay Gupta of the YorkCardiology YouTube channel has lots of great videos on vagal AF and such. Re. an ablation, again, sounds like you're in good hands, two key things are to do it early enough and to go to someone with good results. Has the EP given you a % outcome figure?