Ablation v drugs

[kalgs]

I notice so many people are on their 3rd or 4th ablation. I’m interested in understanding why you would continue if the early ablation doesn’t work ?

Has anyone decided against ablation and decided to stay on drugs instead.

[BobD Volunteer]

All treatments must be considered ongoing .

Arrhythmias change frequently so whilst one may be terminated another appears all too often. Most of the drugs used as anti-arrhythmics are pretty nasty checmicals to take for life and can also be pro-arrhythmic so for example flecainide can promote flutter. It's presonal preference and the human desire to be cured I guess.

[CDreamer]

As BobD says, all treatments are often ongoing, although it’s reasonable to assume you won’t get the people who had one ablation and then had no more AF posting on a forum like this so I think we have to accept that experience posted on this forum may give a slightly skewed view.

My own experience - you consider the benefits and the risks of every suggested treatment and the question I ask myself always is:- Would I be better with or without?

For me - I felt far worse on the drugs, especially Beta Blockers, than with AF so no contest there.

Ablation x2 - First made things worse, second left me AF free for 3 years but when AF did return, I was much less symptomatic for another 2 years.

What helped me was Pacemaker.

So whilst this may not answer your question - I would point out that there are more than 2 options and a 4th might be to not treat at all if you are not that symptomatic - I had AF for some 5 years before I took any treatment.

Many people live in permanent AF and report that they feel a lot better in permanent AF than when they had Paroxysmal AF so if I had my time again and with hindsight - I would have skipped any of the drugs because the side effects were so horrendous for me and gone straight for ablation at an earlier age.

There is no one fix for all, so many factors and individual choices.

[kalgs in reply to CDreamer]

Thanks

[Finvola]

Kalgs, I decided 7-odd years ago to stay on Flecainide and a beta blocker for as long as it was helping me. At that time I was 70, in good health otherwise and was determined to get as much information as I possibly could before committing myself.

My cardiologist wasn't convinced that ablation was the route for me to follow but I saw an EP who gave me the pros and cons as applied in my case. He also kept the door open to ablation at a future date.

Seven years on, and pushing 77, I've had no AF or bad side effects from drugs. I don't regret my decision which was made with factors other than just my own health in mind and every day AF free is a bonus.

[Globe-J]

Hello K,

Unfortunately, there appears a relatively low ablation success rate. I therefore opted for a full Maze Procedure. Happy to report, four years later, back to jogging and AF free,

Best wishes

J (-:

[smn100]

I went down the drug route. I was diagnosed with AF at 40. Its permanent. I've tried all the nasty drugs to convert and it doesn't budge.So figured if the drugs can keep the rate under control I can live with a heart that beats all over the place.

[kalgs in reply to smn100]

So are you on drugs now ?

[smn100 in reply to kalgs]

Yes have been for 10 years

[jeanjeannie50]

I guess it depends how severe our AF is. In our minds AF is only as bad as we ourselves experience, but trust me others can suffer a lot worse. I've had attacks where I've had to struggle to keep conscious and have spent a lot of periods admitted to a hospital ward. I've had other times when I could barely walk from one room in my house to another. I was starting to think that my life was over and I needed to move to a house with no garden. I even posted on this forum for advice on that.

So you ask why some people have more than one ablation, it's with the hope that one day you can live a fairly normal life again.

After 3 ablations and changing my diet to a more plant based and artificial additive free one, I feel I'm now at that stage. Life is good again!

Jean

[kalgs in reply to jeanjeannie50]

Thanks. It’s lovely to hear how you’ve managed .

[Clarrie]

I have suffered with AF since 2015 and was offered an ablation but decided against it as I have had problems with anaesthetic in the past. I was told 30-40% of people have to have a second ablation and whilst the first can be done using the freezing procedure the second has to be done using the burning procedure and under anaesthetic.

Although I get frequent attacks of AF I now have a pacemaker and can cope being on drugs.

[kalgs in reply to Clarrie]

Thanks

[Leechg]

So far I have decided to stay on drugs. I have seen the experts about three times during my 5-6 year journey. The first time I was ready to go for an ablation and was put off by the fact that I could feel they thought the drug route was the way to go. The other times when I have considered it again I have been told "its not without risk you know" and I have been put off. If someone had sat down with me and said that they felt it was a good option for me I would probably have gone ahead. I'm not much of a risk taker. And still undecided.

[kalgs in reply to Leechg]

Thanks

[cuore in reply to Leechg]

Just don't let it go to persistent.

[kalgs in reply to cuore]

Easier “ said than done” ?

[cuore in reply to kalgs]

Generally, one knows that the persistent stage is near when the episodes get more and more frequent and the duration of the episodes get longer and longer. In my opinion, it is at this stage that one should really consider an ablation if one has delayed. My saying, "Just don't let it go to persistent" was to heighten the inevitable path to persistent AF. That is why I made the comment to Leechg. At a prolonged persistent stage, several ablations will be required to maintain sinus rhythm of any duration.

[irene75359]

I am fortunate that my AF hasn't really progressed (as yet!) since diagnosis just over five years ago. Initially I was under a cardiac team doing a trial for different treatments of AF, and they prescribed 100mg flecainide and 1.25mg bisoprolol daily. I then opted for a private appointment with Professor Richard Schilling who wrote to my GP advising that as my AF burden wasn't great, treatment should be as conservative as possible. My GP was very helpful and in total agreement, and I now use flecainide as a PiP along with 1.25 mg bisoprolol, perhaps three to four times a year which stops AF within a couple of hours. There weren't any life-style changes that I could have made, I think I was just unlucky to develop AF.

Coming off flecainide was no problem, I just stopped. Bisoprolol was a different story, with the most unpleasant side effects. But I found out that this could happen, and eventually my heart calmed down.

Sorry, I'm getting there! So in answer to your question, I wouldn't consider an ablation at present, I see the risks as too great for very little gain. If my AF became extremely problematic then obviously I would think again.

[kalgs in reply to irene75359]

Many thanks

[secondtry]

At 60yo with Lone PAF and no comorbidities, I decided to stay on just a medium dose of Flecainide. I was offered an ablation by both cardiologist and EP but the 70% success rate quoted with the likelihood of a necessary second ablation and then no guarantee of success or coming off drugs tipped the scales in favour of a powerful but relatively old tried and tested drug. I am afraid rightly or wrongly I am wary of the whole process of an ablation and will only consider it when QOL drops substantially. In the meantime, I hope improvements will increase its success rate and reduce complications.

[kalgs in reply to secondtry]

Thanks

[doodle68]

Hi Kalgs I have opted for lifestyle changes and medication to deal with my P-AF.

While the frequency of my episodes has progressed over many years and more so since I was diagnosed 4 years ago to a 10 hour episode every 10 days, I can cope with the episodes even though they are highly symptomatic . I don't function very well for the duration of an episode but for the rest of the time I am fine with a good quality of life . The episodes are part of life now, they don't make me anxious now because I know I can cope with them.

I realise my episodes may progress to be come even more frequent and I will deal with that when it happens.

I made my decision to go down this rout for a variety of reason and I have no regrets.

l am retired and live on my own out in the countryside. Content with my own company I don't go out a lot except walking the fields, I don't have to be anywhere and no one relies on me except my dog so if some days I can't do very much that ok, I will settle for that . At 72 I don't expect perfect health .

We are all different, my choice wouldn't suit everyone but it is fine for me.

[kalgs in reply to doodle68]

Thanks

[KMRobbo]

I was not initially in favour of ablation , but after almost 2 years I was fed up with drugs and was fed up with Afib attacks disrupting my life, and was even more fed up with trips to A&E when it would not stop on its own . My last big attack I was in high rate afib, 130 to 195 resting and even higher when moving around for 8 days. I was asymptomatic at those rates, no breathlessness or pain, but it is not safe and I knew also that AFIB begets AFIB, the more you are in it, the more likely you will get it (atrial remodeling). After 5 days in hospital , eventually being cardioverted by flecainide infusion in my local CCU, and then being put on more heavy duty drugs, with side effects, I decided that I was having an ablation! I have not been in AFib since. One side effect of the drugs was that I developed re-entrant atrial flutter promoted by the flecainide I was taking for the AFib, only 9 days after the ablation. That meant a second (small) ablation a month after the first. No flutter since. I have not taken ANY drugs since May 15 2018, and have not been to A&E for anything heart related. Looking back now I should have had the ablation after my 3rd AFib attack , which was 6 months after being diagnosed, as it should have been clear to me it was not going away. I would then have missed out another 9 or 10 afib attacks about 10 nights in hospital, a month of disabling flutter and a crap 10 month period on drugs with undesirable side effects. (hindsight is wonderful).

In contrast both my ablations were in and out the same day!

If I get afib back tomorrow, i would have another ablation to stop it as soon as I could to hopefully get another 3 plus years of drug/hassle free life. That would then be my third.

And that is why people have multi ablations.

[kalgs in reply to KMRobbo]

Thanks

[Maggimunro]

Hi thereOne thing to consider is that there are different types of ablations , in different parts of the heart, for different problems.

An ablation for SVT is relatively simple. The catheter only goes into the tight atrium, doesn’t have to pierce the septum and usually only has a single extra pathway to ablate. This is often done with just sedation.

On the other hand an ablation for an irregular irregular heartbeat necessitates passing the catheter through the septum into the left atrium. The patches of rogue cells transmitting the unwanted extra signals tend to group around the entries of the 4 pulmonary veins coming into the atrium .

There can be literally dozens and dozens of these rogue cells. So mapping all of these extra pathways and then zapping them takes a long time. It also is usually done under a general anaesthetic.

I had 2 ablations for my irregular irregular beats, each lasting 5 1/2 hours because they simply couldn’t get them all the first time.

My ablation for SVT took 3 1/2 hours.

Apart from a few ectopics after my Astra Zenica jab, I have not had a single blip these last 4 years.

[kalgs]

Thanks

[Sheross]

I’ve had 4 ablations this past year all because the arrhythmias were coming from different parts of my atrium. The EP likened it to “whack-a-mole”. I’m now on amiodarone but just started taking it every other day. Last ablation was Feb 10 so it’s too soon to know but I do know that amiodarone is keeping my resting heart rate at 40 which I hate. I’m 58 with congenital heart disease so I’m hoping things work out!

[kalgs in reply to Sheross]

Thanks and lots of luck .

[Barb1]

I have just had the date for my 5th ablation. The others gave me respite for 9 mths up to 5 years. Always staying on all drugs. But I am very symptomatic so to be in SR is amazing.

[kalgs in reply to Barb1]

Thank you

[7164 in reply to Barb1]

Barb15 !!

Never read that.

I have had the one cryo ablation 9 months ago. No Afib but ectopics which cause me anxiety.

I am still constantly thinking about the Afib staying away and worry about having a second ablation. Good thing is no beta blockers etc.

[Barb1 in reply to 7164]

Try magnesium taurate for the ectopic.

[kalgs in reply to Barb1]

Magnesium doesn’t work for me .

[kalgs in reply to 7164]

You know I find the ectopics worse than the PAF . Thanks for the reply

[Cookie24]

I had PAF for a year and just hated never knowing when an episode would happen. I took Flecainide and it did not suit me. So, cryoablation gave me 14 months of freedom. Then, I had a radiofrequency for atypical flutter and ok now for 18 months. Looking back, I recalled my EP telling me up front I might need 2 or more ablations. I will have another if need be.

[kalgs in reply to Cookie24]

Thanks . Were they all general anaesthetic?

[Cookie24 in reply to kalgs]

Yes

[7164 in reply to Cookie24]

Cookie So many of us having 1/2/3/4 ablations trying to stop paf. Then there are the others that advocate living much better QOL by being in permanent af. If permanent is so much easier than the awful paf why are we all trying to avoid permanent. I had the cryo for paf 9 months ago. Only ectopics at this time but I gong the anxiety of ‘if’ and ‘when ‘ is killing me.

So can anyone on this forum confirm the benefits of permanent and stop trying for NSR

Thanks Rod

[kalgs in reply to 7164]

You really make a really important point .certainly about QOL .

[LaceyLady]

I have had an episode on Sunday evening, hadn’t converted til recently. I had appointment with my consultant this morning to discuss everything. His Cardiologist in the hospital had decided I needed a cardioversion, he said definitely not or ablation as I only have very few episodes in a year and usually convert back. Says it’s an option if necessary and I’m ok with that. So just stick to the Flecainide and bisoprolol.

[kalgs in reply to LaceyLady]

Did you have test before starting flecanide?

[LaceyLady in reply to kalgs]

I’ve been on Flecainide since I was first diagnosed. They’d taken various blood tests in A&E. so I don’t know if any specific to do with the drug.

[LaceyLady in reply to kalgs]

What sort of test?