Good Morning, newbie, grateful for your thoughts. Male 66 yrs diagnosed with PAF 6 yrs ago. Frequency of AF increased last couple years but worryingly duration increased also. Admitted to A & E twice in August overnight duration of AF & pulse > 160bpm. Second time diagnosed Atrial Flutter difference remarkable. (I drink alcohol or did but not since Aug & surprise no episodes of AF). Does PAF naturally progress into persistent AF ?. Would Ablation be less efficient if that happens? I'm really concerned about the thought of Ablation should I have it done or keep taking the tablets & maintain abstinence?. As advised listing medication: Flecainide 100mgs & Apixaban 5mg twice a day, Bisoprolol 2.5mg daily , Ramipril, & Atorvastatin. (Bisoprolol & increased dosage of Flecainide since last admission) VMT
To Ablate or not Ablate that is the q... - Atrial Fibrillati...
To Ablate or not Ablate that is the question?
Welcome to the Forum, I am sure all our Members here will offer their valuable words of wisdom and share their own experiences with you. If you would like some advice or information, please visit our A F Association website heartrhythmalliance.org/afa..., you will find a wealth of information, including our online patient resources and details of our HRC2021 Patients Day, which is all available "on demand" the presentations are focussed on helping individuals with AF including the treatment options available.
As you say 'valuable words of wisdom' and very much appreciated by me. Thank you to all that replied. I still have login for Patients Day and will look up other related material. I get that it carries a risk, it's just the thought of such an invasive procedure that scares the bejesus out of me. In the end it maybe necessary, but meanwhile ... Proverbs 30:8
Your are welcome - its good to hear you have watched some of the presentations, you will also have the benefit of revisiting the platform at any time over the next 12 months - please do not hesitate to contact us if you have any questions.
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Lifestyle changes often make a significant difference to AF frequency and intensity so not drinking alcohol has to be good. AF is what is known as a mongrel condition therefore it is impossible to predict how it will evolve but it is known to be a progressive condition there is strong evidence to suggest that it could become persistent over time. Here in the UK, ablations are not easy to come by on the NHS therefore if they are offered, it’s reasonable to assume that the consultant expects a reasonable degree of success. Medics say that the sooner an ablation is carried out after diagnosis the better and it is true that persistent AF is more difficult to ablate but only you can decide what’s best for you……
Ah to be or not to be that is the question, Whether tis nobler to take catheters against the sins of our hearts or take a sea of drugs. (sorry about the Will)
This is always a multifaceted question and sadly not one with a universal answer. What is important is to accept that any and all treatment is primarily for quality of life (QOL). That said many EPs consider that early intervention by ablation does stand the best chance of a good outcome. I had three over a four year period before my AF was terminated in 2008 but I do now have other arrhythmias so it seems that if your heart is of a mind it will take arms against you and cause a sea of troubles (Oh stop it please!)
It is also very important to address all life style issues one of which you apparently have done. Alcohol is an obvious one as it weight loss (BMI less than 26) less stress and avoid over working your heart such as over exercise or flying fighter jets. The LEGACY trials in Australia a few years ago showed how these often removed the need for ablation by reducing the AF burden.
That all said, I have always been a fan of ablation which is not the scary dangerous thing people think it is. Look at any consent form for a medical procedure or operation (Ablation is the former) and you wil see it could have bad outcomes but these forms are to protect the medics from legal action rather than inform the patient. I had a one in many million reaction to something a few years ago and when I looked, yes it was on the list but one top consultant I know told me that in fifty years in the business he had never known it happen. If its your turn then its your turn.
I can only share my own experience in that on being offered ablation for my AF and reading all about it I (to quote the old News of the World) made my excuses and left. The EP did say to call him when I changed my mind and six months later my condition had changed so much that I was begging for the procedure.
This is often asked by members, including myself.
I have had PAF diagnosed since 2013 and Flutter since about 2015.
I too have reservations about the advantages of the proceedure over medication and better self care( reduced stress, better diet etc)
If I was told I HAD to have it to survive, different matter.
As others have said it is not therapeutic but for better quality of life if you are very symptomatic to the point of affecting your enjoyment of life.
If you are not,I really don't think I am going for it
I was placed on the list some time before Covid. (18 month wait in our area) added to that the 18month of that influence and am stable ( touch wood) the last time I was taken in for observation at A E was prior to the placement on the list.
I have had some breakthrough episodes which have been resolved with med adjustments.
I have radically reduced my previous high stress levels which also aggravated my BP. Diet etc too.
I am checked every 6 months by phone at the moment. Also once a year for a bicuspid valve by cardio. All are happy with me ....
It is a dilemma!
Hi , just reading your post . I have a bicuspid valve which was diagnosed 4 years ago along with mild aortic stenosis. I have yearly echo which has shown no progression but my cardiologist says he expects to have to replace the valve within 10 years .Have you had the same prognosis, I'm the only one of my large family to have this condition and also had the pleasure of PAF including a cryo ablation 2 years ago which didn't work unfortunately. I'm on the list for another .
I have a yearly check up and no sign of any stenosis yet. When they explained what it was they said they would keep an eye on me and if it became necessary they could replace it.Hope you go on ok x
Thanks , I think its because there are signs of stenosis he gave that diagnosis in my case. He said 95 out of 100 patients he sees in my situation would be having a valve replacement within 10 years .
Unfortunately you have to deteriorate quite far before they consider the operation, I would have tempted to have it now while I relatively fit and healthy but there's no hope of that happening
Nice talking to you 🙂
I’ve had PAF for 20 years or more and still not persistent/permanent. I had one ablation which ‘failed’ after two years but don’t feel the need of another one as my QOL is not much affected. If you don’t have bad side effects from your meds and lifestyle changes are lessening your episodes then I wouldn’t rush into anything. Certainly don’t have an ablation so you can drink alcohol, not suggesting that’s what you were thinking, but if something is a definite trigger it’s best avoided forever 😕 Flutter ablation is easier and more likely to be successful so that’s a thought? I had both ablated together which is quite common so knowing you already have both is good because it sometimes happens that people have ablation for one condition only to promptly develop the other. Best wishes 💜
Just from your brief notes, I would say get on the ablation list but in the meantime introduce a lot more lifestyle changes. If the latter significantly reduces AF episodes you can always postpone the procedure.
I was offered one 7 yrs ago but postponed partly due to other minor health issues that I felt did not leave me best placed to avoid complications.
Lastly, there is no - right decision - as none of us or the medical experts know how the alternative would have worked out. So its down to your gut feel as to whats best for you.
I had PAF for about 6/7 years and finally I was encouraged to have an ablation, I'm a bit of a coward in that area but agreed on the basis my EP knew my heart better than anyone else. The first was for AF and six months later the second was for Flutter and am so pleased I had them done as I felt I had done the right thing. I did have to try a variation of meds and still take them but my quality of life is so much better now. I was offered an ablation about 18 months prior to agreeing by a Locum cardiologist but felt uncomfortable, so for me it is about having confidence in knowing and trusting your EP/Cardiologist , it just felt right intuitively.
AFib begets AFib- the more you have it, the more you will have it. So if you are wanting an ablation you probably are better getting it sooner ( my opinion) before more Atrial remodelling takes place.My personal experience confirmed that. I went from first occurrence to an attack lasting 8 days ( between 130 and 195 bpm resting) in 2 years. The attack was only terminated by flecainide infusion in my local hospitals coronary care unit. I ha 12 afib attacks with increasing frequency, until this occuence. My Afib was always high rate.
Atrial flutter is different to AFib and is usually , but not always in the right atria, AFib is in the left.
I also developed re entrant Atrial flutter, 9 days after a succesful AFib PVI cryo ablation. I was asymptomatic in AFib ( except the high heart rate) I could run easily whilst in AFib). I could not walk to the kitchen without getting very breathless with flutter. Flutter was 140bpm very constant as rate controlled by the diltiazem I was still taking for AFib.
I had to have another ablation one month after the first to deal with the flutter. Its a simpler ablation being right side with a higher success rate 90% , and little chance of reoccurrence if succesful. It was an RF ablation.
My EP advised that the flutter was most likely promoted by the flecainide I was still taking for the AFib. ( a known issue with flec, that's a reason you take rate control with it, although some people do take flec without rare control).
The EP advised none of my ECGs had shown flutter and it was not present during my cryo ablation. ( I certainly never felt so bad/breathless before which concurs).
He also said if it had been present he could have dealt with it during my AFib ablation, as you get to the left atria by going through the right atria.
I have been AFib and AFlutter free since Jan/Feb 2018, and have not taken any drugs since May 15 2018.
I was fit and healthy and had no other comorbidities.
I never found any triggers for my AFib.
I am not medically trained, just advising my experiences.
Best wishes.
Obviously advice and recommendations from an expert is important. I was concerned about having a Cryo ablation. I had the procedure 6 weeks ago . Best decision I’ve made for years . It was not as bad as I thought it might be . I was conscious throughout.
WE all go through this dilemma at some point, I guess. For me, I was very undecided for quite a long time. I had been on the waiting list for a while when I was offered an ablation at two days notice, with a new EP (to that team) who I'd never heard of, and at a time when I'd just gone 8 months without any sessions of AF. I turned it down, and later discovered that I had then been taken off the waiting list.
Another year goes by, and we get a pandemic, so it gets delayed again.
Meanwhile, when the AF comes it starts to hurt me me more. At first, I could still function. (On one memorable occasion I was giving some people I didn't know a lift back to their hotel from a party I had been at, when it struck. I didn't mention it until my wife an I got back to our caravan in a remote farmer's field, and then just slept it off.) Later, I found that the AF when it came just left me washed out and feeling so unwell, I vowed I would go through with the ablation whenever the next offer came.
Thankfully, I had my ablation at the end of June this year. It was not plain sailing, and I had some horrible and worrisome periods during the recovery period, but I seem much improved now and am very happy that I had it done.
What I'm saying is that it must be your decision, based on how you feel about it, and how much your AF is impacting upon your life.
I couldn’t wait to have an ablation. I had persistent AF which prevented me from enjoying life as I wanted. The thought of leaving my heart to misfire for another 40 years didn’t seem sensible at all.I had one ablation in 2016 and have been free of AF since. I take no medication and live a completely normal life.
Now, if I could only stop injuring myself I could get back to Marathon training.
My AF came on in July and resulted each time in 190bpm for 3-4 hours sometimes 2/3 episodes a day. Waiting lists were over 12 months and I had zip QOL. I was afraid of having an ablation but nobody could help me. So I presented at A&E every single time I had an attack until eventually our new resident EP saw the distress I was in and arranged an ablation for me the following week at Broadgreen with a colleague of his who has a very very good reputation for performing successful ablations. Bottom line I would go through everything for the month’s QOL I have had since having it done. They tell me its a success and I have had nothing at all since the ablation. Very early days but life is so sweet. Check out a good EP, and bang on their door until they perform it!
Get the ablation now before your afib becomes permanent. And it will, it’s only a matter of time and then your odds of a successful ablation greatly decrease.
My PAF progressed in a year. At first every three months and then more frequently and longer episodes. Drugs were not keeping it at bay. I felt awful out-of-rhythm. I had an ablation for afib first and then 14 months later another ablation for atypical flutter. Atypical flutter is left sided and hard to treat. My quality of life improved. In two years, I have a two breakthrough episodes. I still take diltiazem, propafenone, and eliquis.
I’m in a similar position. My lone PAF progressed from every few months or so to every 7-10 days. I ended up in A&E many times, each time I asked the medics for their opinion regarding an ablation as it had been offered to me at the time. They all said it depends on my quality of life and frequently visiting A&E wasn’t a good QOL in their opinion. Each time I ended up in A&E my bisoprolol prescription was increased even though I objected as my natural resting heart rate is mid to low 50’s with low blood pressure. To cut a long story short, I believed the higher dose was slowing my heart rate too much and triggering my Afib. It was reduced back to the lowest dose at my request and I’m now at 10 weeks with no episodes 🤞. Prior to this I’d also made some life changes including losing 2 stone in weight. BMI is now about 25. Stress / constant anxiety absolutely triggers my episodes so I’m working on that too (seeing a therapist).
The last cardiologist I saw (recently) said he wouldn’t recommend an ablation in my shoes but it was entirely my choice. He suggested we keep on the meds to control it due to risks involved in the operation. I thought about it long and hard and based on how I’m now feeling (and my research) I’m not opting for the ablation. If things change then I will. I’m hoping with the life changes I can go at least a year and more with a lower afib burden. If the op can only last a few years before a touch up is needed I’d prefer to wait and see how my afib progresses with my life changes first. I am very much a scaredy-cat when it comes to ops though which no doubt has also informed my decision.
It’s such an individual choice. Good luck with your decision.
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