Confused- ablate or not: Well, after a 3rd... - AF Association

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Confused- ablate or not

Harbie profile image

Well, after a 3rd visit to a cardiologist (always a different one) since being diagnosed with lone afib a few years ago, I’m confused! My episodes are now more frequent and last longer. My cardiologist recommended I don’t go down the ablate route but instead keep trying meds to control it. My heart is apparently strong. He said, although rare, he’s sees people for whom the ablation caused permanent long term health problems- including one of his cardiologist colleagues. It’s my choice. He will refer me to an EP but in my shoes he wouldn’t try that route yet. As I type I’m in afib. Seems to be every 10 days now. He wasn’t convinced about my comment (from my research) that waiting too long lessens the chance of ablation success. Do I opt for referral anyway and discuss with EP?

96 Replies

I can only speak for myself, I would, I did. Even if you only discuss with an EP I think you will get a less biased view (I suspect that your cardiologist’s view has been coloured by his colleague’s experience) from an EP who is the specialist who would perform such a procedure. I am probably more biased against the medications because they did me more harm than good.

Just check out how many ablations your EP performs each year and how many are successful after 12 months before you decide whether or not to go for it as there are undoubtedly risks involved, as with any procedure and there is no guarantee of success and recovery for some is a lot longer than you are told but when it does work the relief of AF burden is enormous.

Harbie profile image
Harbie in reply to CDreamer

Thank you. I saw him on Monday and said I’d ponder as I can call and ask for referral at any time. As I ponder I’m inclined to think I should do what you suggest. He scared me a little to be honest as I’d made my mind up to take the (previously offered) ablation route before my appointment.

BobD profile image
BobDVolunteer

Yes. EPs are the experts in arrhythmias like AF. They are the electricians. Plumbers (cardiologists) are often anti ablation for whatever reason.

What is important to understand is that in general any and all treatment is only for quality of life as it is not considered a terminal condition. Also there is no difference in long term outcome between any treatment so long as heart rate is well controlled and the patient anticoagulated for stroke prevention. It is also vital that you remember that ablation is part of ongoing treatment and may need to be repeated.

When I was first diagnosed in 2004 I was offered and declined an ablation as I didn't like the sound of it and told "when you change your mind come back and tell us. " Within six months my AF had progessed (as it will ) and I was begging for an ablation. I had three up to 2008 when my AF was terminated and very grateful indeed for every moment of NSR since then.

jeanjeannie50 profile image
jeanjeannie50 in reply to BobD

Is your tachycardia cured now Bob?

BobD profile image
BobDVolunteer in reply to jeanjeannie50

What does cured mean Jean? My rate varies from mid fifties to mid 90s in a random way for no apparent reason but in general it is manageable. No AF which is good though. Since "normal" is 60 to 100 I am not considered in need of much in the way of treatment.

jeanjeannie50 profile image
jeanjeannie50 in reply to BobD

Cured to my mind means - no heart arrhythmias . Sounds like you are much the same as me now and can lead a normal life.

HiloHairy profile image
HiloHairy in reply to BobD

Your rate varies quite a bit but do you stay in sinus rhythm?

BobD profile image
BobDVolunteer in reply to HiloHairy

Yes of course. Not had AF since 2008. Had ablation for atrial tachycardia in 2019 and no violent epsiodes since but still have wildly varying HR whilst resting and rate stays up for ages post effort or exercise. I think the thottle box needs some adjustment.

CDreamer profile image
CDreamer in reply to BobD

Cured means no recurrence of the condition after 5 years.

BobD profile image
BobDVolunteer in reply to CDreamer

OK so my AF was cured but I still have other arrhythmias. AF is not the only fruit. lol 😁

Interesting Dreamer - I was under the impression it could not be cured ! I come from a family where myself and four sisters and father have /had it - my eldest sister is 89, my youngest 69, the rest of us slot in between those two extremes! However, my son, an extreme sportsman (canoeing, white water rafting, mountain biking etc.) developed it 16 years ago and had an ablation - we live in South Africa and there are no EPs in our area, so he had to go to Cape Town. He was told shortly after the procedure by his local cardiologist and fellow canoeist, that he was cured and could carry on with his sports, which he has done with no ill effects and regular check ups. I have always argued with him that the perceived wisdom is there is no cure. Your comment has made me think again !!!!

That is the technical definition. Many conditions return after 5 years.

Harbie profile image
Harbie in reply to BobD

When I was first offered an ablation (by a different cardiologist) last year I declined for the same reasons. The latest cardiologist said ultimately there isn’t a definite best route for me at the present time so he can’t tell me what to do for the best, only advise what he’d do in my shoes. It’s ultimately my decision armed with the pros n cons. Wish I had a crystal ball 🙄

Espeegee profile image
Espeegee in reply to Harbie

If you ever get a crystal ball let me know lol, I'll be round for a go.

snak3eyes profile image
snak3eyes in reply to BobD

the plumbers and electricians analogy is spot on!

The cardiologists I've been to, never mentioned anything about seeing an EP. I've come to the conclusion that I need an EP myself.

Up here in NE Scotland the cardiologist is an EP

All EP's are cardiologists but not all cardiologists are EP's.

IsobelBrown54 profile image
IsobelBrown54 in reply to BobD

I was pleased to read of your experience as I am now being referred for ablation after 8 years of paroxysmal Afib and two electric cardio versions this year. I was dubious about success rates of ablation, but hearing that after 3 ablation you have been free of Afib for 13 years is most encouraging!Thanks!

Average number of ablation to fix AF is 1.54 I read?

AF increases stroke risk by factor of 4 or 5? So it’s not just quality of life, although it seems there’s an increased risk of stroke during/just after the ablation but longer term it’s reduced because there’s a 50-80% chance that ablation will rid you of AF?

Stroke risk doesn’t always disappear with the AF. Most people continue with anticoagulants after ablation but medical views differ on this subject & assess need based more on other Risk factors.

BobD profile image
BobDVolunteer in reply to splashrollandplod

I repeat, there is no difference in long term outcome whatever treatment be it rate control drugs, rhythm control drugs or ablation. Anticoagulation reduces stroke risk by 70%.

Diver2 profile image
Diver2 in reply to BobD

The studies I’ve read point to better outcomes with drugs in a wider population than ablations. I haven’t met anyone who was cured of Afib and didn’t have other arrhythmias as a result of the ablations.

Diver2 profile image
Diver2 in reply to Diver2

The best advise you’ll get is the EP. He is the specialist. Whether he is more or less biased because he does the surgery is own forcdebate

I definitely would go to consult with an EP. You have nothing to lose by consulting with the EP but some knowledge to gain and a different perspective on your condition from a specialist. A cardiologist is seen as a plumber whereas our problems stem from electrical impulses so need an electrician which is what an EP is. You still do not have to go down the ablation route if you don't want to but it is definitely worth talking to an EP and getting their opinion.

Harbie profile image
Harbie in reply to Desanthony

Yes, thank you. I think I’m pretty much at that decision - what harm can a consultation do - I can then commit or not.

So here's my pennyworth.

I've had AF for 16 years, three ablations and numerous cardioversions. I'm now in constant AF, but it's nowhere near as bad as attacks of PAF.

Please, please look at your diet and avoid all food and drink containing artificial additives. Cut out as much sugar as you can and try to get more exercise, lose weight if needed. I believe that is what has benefitted me the most. Artificial sweeteners were a sure trigger for me. How I wish someone had told me that right at the start of my AF, though I probably wouldn't have listened. I thought my first ablation was going to cure me, but it actually made my attacks worse, my second didn't help either, though I believe my third may have, but by then I was into a healthy diet, so who knows.

Don't rush into an ablation, until you have seriously tried the diet option.

Jean

Harbie profile image
Harbie in reply to jeanjeannie50

Hi Jean Jeannie, thank you. Yes, I quite dramatically changed my diet and lifestyle after reading the Afib cure and generally learning more about the condition. It did seem to initially make a difference which raised my hopes, but only short lived unfortunately. I think I’m in afib now as it started a few hours after I heard a good friend of mine died (unexpectedly) yesterday. Even so, my episodes are far more frequent with or without shock news!

I find the ablation decision terribly difficult at the moment but as others have said, it can’t do any harm to chat to an EP for their perspective.

jeanjeannie50 profile image
jeanjeannie50 in reply to Harbie

Of course it can do harm. EP's need people to do ablations on to earn their living! You're having the inside of your heart burnt or frozen. This forms scar tissue. At one stage, while hospitalised because of my AF a cardiologist said that scar tissue had probably made my heart stiff in it's working.

Saying that some people do have successful ablations.

Harbie profile image
Harbie in reply to jeanjeannie50

That’s an interesting perspective. I do recall Dr Gupta discussing the implications of an ablation in a similar vein.

Choosing my words carefully Jean, I don’t think Harbie is suggesting that an ablation is not subject to risk or consequent harm, more that it wouldn’t do any harm to have a chat with an EP to help assess her situation. With regard to the need to earn a living, this may be the case in countries where treatment is payed for privately or by health insurance. Here in the UK we wouldn’t have patients having to wait 12 months or more if there was any shortage work, From what I hear, given the current climate, specialists are only allowed to carry out an ablation if they are reasonably confident that the procedure will be successful.

I guess I can only judge by my EP. He's only interested in people having ablations. Now that I've had 3 and he's said I'm not suitable for any more, he has discharged me from his care.

Your right, we can only make comments based on our own experiences. I’ve been lucky in that all my experience which I share here has come from health professionals who are prepared to give their support to various support groups and, of course, the AF Association. No disrespect to anyone but by the law of averages, not all health professionals may be so accommodating….🤔.

Let’s hope the vast majority will have their patients best interests in mind when offering advice.

The self-preservation motive of the EP is a serious issue.

I'm in the US where most doctors are in private practices. However, I'm a member of Kaiser Permanente, an insurance system with their own doctors and facilities which is as close to the UK socialized medicine model as we have here. Kaiser membership is very popular in the state where I live where we have a population of 1.6 million and only one Kaiser EP.

Because of the above there appears to be no eagerness to perform the procedure. My cardiologist and my primary care physician have been requesting my ablation for several months. Just this week I received an email that our one EP will have a video meeting with me in about a month. I fully expect him to attempt to persuade me to stay on the drugs that take the joy out of my life.

Morphus profile image
Morphus in reply to HiloHairy

I faced the same resistance to ablation with Kaiser in California. Finally switched to Cigna and an now seeing a top notch EP who will be performing ablation. He firmly believes early intervention increases success rate for preventing or delaying Afib incidences with aging. I have Paroxysmal Afib.

HiloHairy profile image
HiloHairy in reply to Morphus

Has the EP given you an idea of how long a recuperation time to expect?

I ask because the UK members here typically talk about it being several months to a year while the cardiologists here in Hawaii I've spoken with have all said that it's a quick recovery and then I'd be back in the gym in a few weeks.

Morphus profile image
Morphus in reply to HiloHairy

Says a few weeks recovery than back to normal.

We don't have EPs in the area where I live, but we do have lovely Cardiologists, so I have to rely on the plumber - mind you, when my hot water geyser needed replacing, the plumber made a good job of both the water and electrical installations !!!!!!!!

It’s the point where the pulmonary veins enter the top of the left ventricle isn’t it? 4 small areas, not sure stiff heart?

I had three ablations (you know these form scar tissue to block the rogue signals getting through) and it was after my second one, when I was hospitalised with a severe AF attack and this was what the cardiologist suggested. It's not me making it up. Are you a cardiologist?

Study reported in National Library of Medicine (US):

Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors

Conclusions: After radiofrequency catheter ablation of atrial fibrillation (RFCAF), PH with LA diastolic dysfunction or the so-called stiff LA syndrome is a rare but potentially significant complication of AF ablation. Severe LA scarring, LA ≤45 mm, diabetes mellitus, OSA, and high LA pressure are clinical variables that predict the development of this syndrome. The main clinical findings include dyspnea, congestive heart failure, PH, and large V waves on pulmonary capillary wedge pressure (PCWP) or LA pressure tracings in the absence of mitral regurgitation.

Thank you, that's interesting, it's something that's rarely talked about on this forum.

And give up alcohol - I managed to and don’t miss it too much

Yes. I gave up alcohol (very grudgingly) about 2 years ago. Actually feel better for it and don’t miss it as much as I thought I would.

Hi Jean. A bit like you I wish I had had the info regarding diet and the like when I was diagnosed all those years ago. I think it would have helped a lot. I have lost weight, cut out sugar , caffeine, alcohol, keep moving as best I can and trying to keep my stress levels down. I have had 3 ablations but no luck for me and things got worse sadly, but I know people who have had just one and been fine and that hopefully will give others confidence to go down that route if they follow the diet advice. I have picked up so much advice from this forum and the Afib Cure book. I didn't get that sort of advice from anyone else and I didn't know about this site when I started down the afib road. Why dont cardiologist have this forums info to give to people? I seemed to find it by accident. Lucky I did, you guys are so supportive. Thank you. 🌻🌻🌻

Jean, artificial sweetners do it for me! My last attack a few months ago, came after I rather foolishly decided Slimfast was a good idea....not

That's interesting.

I was overloading my body with artificial sweeteners, they were in the yogurts I ate, the lemonade and tea I drank, sweets etc. I suddenly noticed that every time I had crumble for dessert at work my heart would take off and I discovered that contained artificial sweeteners so it would be suitable for diabetic patients. I avoid them all now and am staying quite well.

It takes ages for the penny to drop doesn't it!

Jean

It does Jean, surprising how we learn as we go along!,😊😉

This is one of the most common questions we are asked on this forum and to some extent, it’s one of the more difficult ones to answer. Like you, I was diagnosed with lone AF back in 2014 but mine was persistent. The cardiologist (not an EP) who then led a support group I belonged to was generally not particularly supportive of the ablation route. Also like you, I was in a dilemma about what treatment to pursue after my CV began to fail in 2015 but when asked directly, he said that if he was me, he would opt for an ablation. I did, and having had two I am still in NSR. About a year ago I posted the following and you might find the replies helpful.

healthunlocked.com/afassoci...

You also need to bear in mind that pre-Covid, around 8000 ablations were performed a year just in the UK. It’s very rare for anyone on this forum, to say they regret having theirs although we do get many issues raised from members during the 3 to 6 month or so blanking period after the procedure. This suggests that the vast majority are pleased with the outcome and have probably disappeared from the forum to get on with their lives.

If I were you, I would certainly discuss your own situation with an EP and if offered an ablation, take it on the basis that currently, the waiting period is likely to be 12 months. This will give you plenty of time to change your mind if your situation changes. Hope this helps, but also look at the related posts which appear top right of this page but only you can make the final decision……

Harbie profile image
Harbie in reply to FlapJack

Thank you FlapJack. I’ve now made the decision to be referred. As you say, the wait alone will give me time to decide based on what happens next.

Eadaoin profile image
Eadaoin in reply to Harbie

Well done. It will not be a cure but you should have a better quality of life if you do have it done. It’s quick and painless and only day surgery. For me the anxiety leading up to it was worse than the procedure itself. Mine was done in a Catheter Lab not an Op Room. I had sedation. Trust your EP’s advice. Good luck.

I would go and see an EP,my AF become more frequent roughly weekly,had my ablation in March if needed would have another,you will get all the facts and you can then make a decision.

The only thing I'd add is that the advice given to choose your EP based on experience and success is all very well in theory but as I've been told by mine,may very well not be him on the day (IF I have it done)So pretty pointless choosing one.

It's a real dilemma. X

Harbie profile image
Harbie in reply to wilsond

Oh blimey. Something else in the mix. Thank you for the heads up.

wilsond profile image
wilsond in reply to Harbie

I thought people should be aware of this possibility as I didn't know myself. Someone I know found a complete stranger gowned up! Unsettling.It's a big decision to make. It's strange that if we need heart surgery like a bypass etc we seem to accept it!

Good luckhave you been offered Flecanide as an antiarrhythmic,? Works very well for me.

My AF and Flutter have not got worse, in fact improved greatly since I was diagnosed in 2013. I'm sure I was so stressed and anxious at the beginning that it had a lasting effect for a long while.

Good luck xx

Harbie profile image
Harbie in reply to wilsond

Hi wilsond, I do think stress is very relevant in my case and have always said so to the medics from the start. I do have flecanide as a pip. Didn't work for me but the cardiologist suggested I double the dose. I did this morning and I think it worked. Won’t know until it happens again though as afib is such a variable - it might’ve stopped without it. If I’m honest I’d much rather avoid surgery (wouldn’t we all) but not at the expense of missing the window of success if it turns persistent etc. I’ve read so much about the condition that words are spilling out of my eyes and ears. Lol. It’s such an individual condition……..

saulger profile image
saulger in reply to Harbie

Hello Harbie. I've read your and other comments so far. I have paroxysmal AFib and decided to take twice a day morning and evening, before food, just 25mg of Flecainide (half the recommended 50mg dose).For me it's been miraculous, with rare episodes and shorter lasting.

I also found that my AFib tend to start when I've missed a day and more of bowel movement (vagal connection?). If you suffer from IBS or similar, there may be a link.

Good luck with your decision.

I think Jeanie's reply to you is so sensible, Try everything before you do the surgery bit. Magnesium has belped me a lot. Good diet is a must, and artificial sweeteners and alchohol are a no no. Try to find out what triggers your AF and read, read and read all the information you can. Stress and anxiety makes matters worse and is a trigger for me. You sound very anxious. Just remjnd yourself this is not life threatening. I wish you all the best. Just take your time.

Harbie profile image
Harbie in reply to Cavalierrubie

Thank you. Yes, I’m a great ponderer and gatherer of facts. I’ll let it all settle and digest.

FancyPants54 profile image
FancyPants54 in reply to Harbie

You have another option. Live with it. I had very violent bouts of AF about once every 8-10 months for years. It was horrible, so banging and unsettling. I never went to hospital with it. GP said no point. It always resolved after 10-36hrs. It floored me. All I could do was sit and wait for it to pass.

One day it started and didn't stop. That scared me a lot so it was back to the GP. Put on a beta blocker (I was already on an anticoagulant) and sent home. I'd stressed myself so much that my heart rate ended up 130+ and I went back. Saw an elderly locum and got sent to A&E (more stress). There they assessed me and then put me into a day ward to be seen by doctors. I didn't see a cardiologist but they got my heart rate down and calmed me. That was about 2 years ago. I've been fine since. In persistent AF, but I can't feel it most of the time and if I do, it's not for long and it's not bad. If I were not struggling so much with hypothyroidism (which is, I am sure, directly linked to my AF) which doesn't get helped with standard NHS medication, I could do anything I wanted.

I don't even believe all this panic about changing diet. I've seen it all before in the thyroid groups. People get diagnosed, panic and think what can I do to stop this and the only thing they have access too is some drastic diet change so they launch into it and then convince themselves it's the cure. It never is. It might be part of it for some people. I switched to steam decaffeinated tea and coffee when I was first diagnosed with lone AF, so many years ago. But I eat a lot of dark chocolate with high coco content and no issue. I can have a real tea or coffee with no issue. I just choose not too most of the time. I'm very overweight now due to the hypothyroidism and inability to exercise because of the pain it gives me. It annoys the heck out of me as I was so fit before even with lone AF. But I'm not stressing about that. Changing diet is stressful. Not interested. If I can get on top of my hypothyroidism then the weight will come off and I will want to eat the right things again. I don't believe in cutting anything out forever.

So the reason for my long essay is that you can live a much more comfortable and normal life with persistent AF so don't worry about that happening. A number of my relatives have it and live with it. My Dad was the one who was on a lot of medications and had a miserable life. But then he never did as the doctors told him. He had major open heart surgery at the age of 80 when they repaired a valve and gave him a maze procedure that didn't work. He'd already had a failed ablation. But after that surgery they told him he must walk every day. I don't think he ever did.

Try to calm down about this and to put it to the back of your mind more. Have the normal day to day life at the forefront. Don't try to think your way through everything. See an EP (I will one day, but for now I have 6 month cardiology checks, or did before the pandemic shut it all down) and see what they have to say. But it's not a rush. Take your time. Don't be afraid of persistent.

Harbie profile image
Harbie in reply to FancyPants54

Thanks FancyPants, that’s an interesting perspective - always welcome and useful. I’m still pondering. If I had a pipe I’d be sitting by the fire quietly reflecting and considering my options. 😜

Hi Harbie,

Ablation and drugs are not the only options.

Best wishes

J

Visigoth profile image
Visigoth in reply to Globe-J

Please could you expand on that?

Yes, discuss with EP. Afib begets Afib - the more you have it, the more you will have it. ( was also my own experience) . Over 3.5 years post ablation , no afib , no meds.

Maybe I missed something, but if you are having AF episodes every 10 days or so, then moving onto regular anti-arrhythymic medication (rather than just taking it as a PiP) would be a common next step.

Good idea to consult with an EP in case your AF worsens, or fails to be controlled by medication.

I was going to say that! You haven’t really given a drug regime a ‘proper go’ if you’ve only been on PIP. I’m not impressed with your cardiologist if he hasn’t suggested that - combined with bisoprolol or similar to prevent flutter.

I was in the same position. My doctor said to stay on drugs and my first cardiologist who was not an EP said the same. When I had an episode that ended in hospital the EP said he would always recommend an ablation if it was available. EPs seem very convinced and to be fair to my first cardiologist he said he himself is a 'plumber' and you should always listen to the 'electrician'. Make sure you talk only to an experienced EP. I had the ablation and have never looked back, two years in and my health and well being are a 100% improved without all the drugs. Good luck.

I’m in much the same position as you Harbie. To ablate or not. Discussion with EP and as a result going to try 4 months of new medication. If no improvement then probably will go for the ablation. Wish you well

Harbie profile image
Harbie in reply to Nan1

Ah yes. The cardiologist said he’ll see me in 4 months time to review how I’m doing. Still looking for that crystal ball. Lol.

I agree with KMRobbo! See an EP! I saw two private cardiologists (fear i would wait too long on NHS) one was an EPs one not, who recommended beta blockers and flecainide. The EP said think about ablation in the future.

Meanwhile my NHS cardiology service appointment had swiftly appeared! I had asked to see an EP recommended by a medic friend of mine who said he was the best, he did no private work only NHS and was completely up to date on research, GP happy to refer. GP said it would be months for appointment (hence private visit) but our local cardiology service fast forwards AF referrals to EPs, and four weeks later I was seen. He was absolutely of the view that 1) if your heart was suitable 2) if you were medically fit 3) AF not permanent- then consider early ablation as AF begets AF, and too much fierce AF can cause other heart issues later. He also said that in my case beta blockers counter indicated, could even trigger an episode.

My ablation in November was straightforward (despite in Covid) and I have had one very brief episode since (7 months later) but not the 8 hour disrupters I had before. However, by the time of the ablation I had only had about 7 (deeply unpleasant) episodes. Arrhythmia nurse said to discuss the “blip” at my follow up next month having given a few more months post ablation for heart to settle down. Would I have a “touch up” ablation if more “blips”? I’m not sure, but I trusted the expert EP and will listen to what he says.

(He also said he would do the procedure himself - and did).

I want to add that for all my adult life my diet was excellent, I have never used artificial sweeteners, rarely ate sugary stuff, eat lots of fruit and veg and little meat. I was low to normal BMI.

Alcohol turned out to be a trigger though and I do miss it!

I really can’t blame a bad diet for AF. I don’t get much exercise because I have bad hip and back problems leading to mobility problems. So, all the lifestyle advice may be good general health stuff but has limitations!

So, see an EP, take a list of questions, tape the session on your phone, maybe talk it through with the arrhythmia nurse (if your service has one).

And jolly good luck…

I think you may well get a different answer and attitude from a EP harbie 👍

Harbie.. something else to consider is are you fit enough for surgery / procedure at present let alone in 6-12-18 months time.. none of us are getting younger dare I say .. but good luck with your decision..Im 8 years Af free.. he says with fingers crossed..😉

Your Lone PAF has to be stopped - with 2 episodes a week I was offered an ablation by 2 cardiologists & an EP. I would certainly not discourage you from seeing an EP but as others have said it is a lottery whether it is any use. In my case he was rushed (behind in his clinic) & was keen to show me the door. It was useful though in that his comment ' ...70% chance of success & another ablation probable..' confirmed to me to postpone that route.

I went back to my cardiologist, who did not agree to Flecainide PIP but did agree to my proposal to try upping the Flecainide dose to a medium level of 200mgs/day. He believes the heart needs a stable routine and I have extended that by making my lifestyle more stable. As a result had 7 good years with high QOL.

You seem to have done a lot of the right things but probably more game-changing action required on stress reduction. Good luck with your decision, the bottom line is go with your gut feel. If you do choose an ablation, make sure you are in peak health for it with some extra Vit C & other support.

I guess it's true that a cardiologist who has trained to do EP will be inclined to carry out an ablation but that doesn't make their recommendation necessarily better than your current cardiologist's. It must also be so that your current doctor's advice will have been given after weighing up your individual situation and that the doctor will well know that the weight of clinical evidence is, unquestionably, for early ablation. If you've had echo or MRI scans, then your doctor will know the thickness of the atrial wall, the nearness of the oesophagus to the atrial pericardium, and much more, especially regarding such things as degrees of heart block and so on.

It's difficult to know what to do. I think that if I were you, I would ask or pay to see an electrophysiologist, maybe at the same centre (although that will create its own issues) and discuss your current cardiologist's views with him or her.

Steve

I am amazed that there has not been any mention of the carpet seller in this thread. The phrase I refer to is "If you go to a carpet seller, he'll probably sell you a carpet". Having said that (mainly for amusement) it is undoubtedly true that an EP will be the person to recommend an ablation. However, my very limited experience of cardiologists does not recommend them to me for the electrical problems of the heart, and I would not hesitate to see an EP. They are the experts, and most likely to know the best treatment.

I’d get a second opinion from another cardiologist. His reasons - long term health issues caused by ablation don’t stack up with evidence? You need to understand the risks eg 1 in 1,000 risk of death, 1 in 200 of a complication. But 1 in 1,000 ….. so the average 65 year old man has a 1 in 70 risk of death from all causes in a year. So ablation is like having an extra month of risk this year. I am 65, got paroxysmal AF 2 years ago, have had it 12 more times since, always self reverted in a few hours. But the ‘burden’ got bigger 5 weeks ago - semi symptomatic, getting it when not exercising - and so mhh the cardiologist invited me for an ablation which I had last week. Week 1 recovery was bumpy but no complications and now I’m well on the road and hopeful AF is gone.

If you have a strong otherwise healthy heart and your fitness is good then I’d hope like me you’d be fine having ablation. My resting HR is up from 60 to 74 but that’s expected and will likely fall to mid 60s.

It’s your choice, research, consult and decide.

Dear Harbie, thank you so much for posting this. I’m in a very similar situation and unsure about what to do. I will read what others say with great interest and I hope that the AFib that you’re having now, stops really, really soon. 🙏

Hi Slidingdoors, it stopped after 9 hours and 2nd flecanide pip. Thank you. Good luck with your decision making.

Thank you and thank goodness that that horrible feeling has stopped for you now. Since my post to you I have read everything that was posted to you. So interesting to read those different views… I haven’t spoken to the ‘electrician’ yet, but expect an appointment soon. To be honest, I still don’t know what to do!

Me neither. 🤷‍♀️ I’m going to discuss with EP (ask for a referral) and then decide. In the meantime I’ll see how my afib burden is during the wait. I get less and less anxious about it which also helps. For me, at the moment if meds can control it, I’ll stick with that. But I might change my mind next week! 🙄

I had infrequent AFIB events but I hated each one and I was very uncomfortable with being on blood thinners. My original cardiologist thought I would be fine just be taking meds. When I moved to TX the cardiologist, after a very uncomfortable episode of AFIB referred me to an EP. I did have the ablation and, although I was very nervous about doing it, I am so happy I did. The procedure is long but being under anesthesia made it easy. The hardest part was lying still for the hours after but that was OK as well. The ablation has been life changing for me. During the procedure the EP found a “misfire” that was genetic and he says I probably had it all my life and did not know it. That would explain incidents when my heart would race for no reason. That likely contributed to the AFIB. He ablated that as well as AFIB and A-Flutter. Since the ablation I have so far had no episodes of AF and it has been 3 months. At the 4 months mark I can go off Eliquis. I had a loop recorder inserted (I highly recommend for peace of mind. You don't even know it is there). That way there is no question as to whether or not I have had an incident of AFIB or any other irregularity. After I go off the meds, the doctor will continue to get a daily report from the loop recorder so I don’t have to worry that I am missing something. If he sees any sign of AFIB we will revisit the need for meds but he is not expecting that to happen. My biggest goal was to calm my heart and to get off the meds. So far, my heart is so happy, as is my blood pressure and I hope to soon be free of blood thinners. I know of two others (both doctors) who had the ablation and both would definitely do it again if need be. Good luck to you.

Thank you. That’s interesting. I’m pleased it was so successful for you.

Please explain the inserted loop recorder and will it be temporary? Also my EP at theMayo Clinic said I would be on Eliquis for the rest of my life. Did you have any ill effects from the “long” GA?

The loop recorder is a small device that is implanted just under your skin over your heart. It basically records the heart rate and any events such as missed beats, extra beats, AFIB or any irregular heartbeats. I did it before the ablation.They implant this small device in the office during a regular visit. The skin is numbed and it doesn’t take long. It doesn’t hurt and when the small area heals which is quick it doesn’t even show. You don’t need to change anything about your daily life. You can even have a mammogram or MRI with no issues. Mine will be in for 4 years and if need be, or if I or my doctor want me to continue, it can be replaced at that time. The doctor inserts it but the company that makes it has a nurse there as well so they can see that it is accurately showing your EKG on their monitor. This device provides the doctor with a 24/7 EKG of your heart.

There is a small unit that looks like an I-Phone that you plug in within 6 ft. of your bed and leave it there. Sometime (mine is around 1-3 AM) while you sleep it sends the previous 24-hour report directly to you doctor. If there are any irregularities the doctor will get an alert as well along with the report. It gives me complete peace of mind as the doctor will not have me discontinue Eliquis unless he is certain I have had no issues. When I do go off Eliquis the doctor will let me know if I need to resume it, otherwise I just go about my life without the worry that I am missing something. The unit that is placed next to the bed is easy to take with you if you travel. Just plug it into the outlet at the hotel. It’s so easy.

My doctor gave me the choice of having the loop recorder or he said I could monitor my heart rate for any irregularities via my I-Phone. I chose the recorder for consistency and accuracy. I am very happy that I did. Mine is made by Biotronik but there are probably others out there. You can find it on the internet. It is very interesting.

There were a couple of times following the ablation that I felt some odd sensations, which is normal but made me a bit anxious. Just so I would feel better I called the doctor and each time they told me to relax, they were just skipped beats or something that was not worrisome. It keeps me from getting worked up about something if you know what I mean. This devise is certainly worth looking in to.

Sorry this is so long. It’s just hard to explain in a shorter version.

Also, I'm not sure what you mean by the long GA but if you mean the ablation, no. It was actually very easy. I would not hesitate to do it again if need be.

Thank you so much for your detailed explanation. I will check out the Biotronik device. I never liked the idea of being leashed to an Apple Watch. I am still on the fence about ablation.

Same here - I don't know how often they are fitted but......the loop recorder meant that every time AF/PAF/FLUTTER/ectopics etc happened anytime of day or night, sometimes for 10 hours + I would just click the small hand held device it comes with & a later date could talk to the cardio nurse/cardiologist about it as it is very accurate. At consultations the cardioligist has all the information in front of him linked to his screen at the hospital. Eg - was told my hr was 153bpm for a short time one day but I was unaware of it! As a result of this simple procedure/device my treatment/meds have been tweaked & changed from time to time. Never heard of it until cardiologist suggested it, pity it isn't talked about very much. It's certainly given me peace of mind. Worth asking about?

I am in a similar situation as you Harbie. I have been suffering with afib attacks for more than 10 years. Over a period the frequency has increased and I now expect one about every 2/3 weeks. They have lessened however in respect of violence. In fact I sometimes only know I am having an attack by the frequence of my need to urinate. Attacks are almost always at night while in bed. They last 6/12 hours. I, like you, fluctuate between having an ablation or not.

For the past year I have been sending the EP recordings of my attacks and he seems to be in two minds as to whether I need an ablation. He tells me it is on offer when if I want it. I am due my next consultation in January. Currently I am totally unsure.

Harbie profile image
Harbie in reply to Coeurdelion

For me it’s not an easy decision as I too usually (not always) feel pretty much ok during an episode. The couple of times I felt rough I’m now not convinced it wasn’t anxiety. My heart rate stays below 80bpm during an episode since low dose bisoprolol prescribed. I’ve decided I will see an EP but if he’s unsure I’ll carry on until (or if) meds don’t work. According to cardiologist I have a few options yet with the meds. Mind you, it’s an unpredictable beast so who know this time next year…….🤷‍♀️I wish you luck with your decision making.

It’s a personal choice. My husband had an ablation 8 weeks ago and it was not what he thought it would be. Lots of after effects he was not told about. And still in afib.

Harbie profile image
Harbie in reply to luvthebeach

Oh cripes. I do hope it’s part of the process and he recovers soon. 🙏

I would definitely see an EP. As has already been said they are the experts. I wish I'd seen an EP earlier than I did. The more areas that need ablating the more difficult it seems to be for the EP to get them all ablated, which is where I am now. Just my thoughts. Best to you. I know it can all be very confusing at times.

Coeurdelion profile image
Coeurdelion in reply to Tux18

And so the debate continues. One never knows. I think if in doubt, leave it out. When I have an attack it is not too bad. I just rest, usually laying down, and wait for it to pass. I usually feel tired after the attack until the rhythm returns to normal. I then check my blood pressure, heart rate etc and have very good readings. It feels that the attack has reset my body rhythms. Much like the way one resets one's devices when they go wrong. A quick reset and all is well.

Definitely get a 2nd opinion, and likely from an EP. True there can complications, but the ablation tech is improving to help minimize this all the time.

You must do what you want to do ... however, my cardiologist talks about ablation ... and there is no way that I would have an ablation. But that is just me. There are pros and cons ... for every pro, there is a con ... and vice versa. Best.

I’ll echo what others have said. An EP is the specialist in these things. A good one will consider the pros and cons of meds vs ablation. Armed with good info, you’ll be in a better place to decide.

It took me years to find the right Cardiologist to send me in the Ablation route. One thing he wanted me to do was get a Afib monitor because I was never in Afib during the Holter Monitor or office visits. Over the next month I filled his inbox with recordings. I got my Ablation 3 months later. You might need to look into another Cardio Dr. I went through some to get the attention I needed.

Do your homework ...get one of these and prove your point. I wish you well.

amazon.com/Alivecor%C2%AE-K...

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