Anyone have ablation for asymptomatic afib/aflutter?

[nmack]

Hi. I appreciate the great answers and support from my previous question on this forum. I know the main reason for ablation is to eiminate afib, improve QoL and hopefully get off of the meds. This may be a stupid question but are there many people with asymptomatic afib/aflutter and heartrate of 70-80 bpm and good QoL that elect to have an ablation just to acheive NSR and reduce the future risk of stroke, heart attack or heart failure, etc? I'm 68 and have had asymptomatic afib for 2 years (and now flutter) but am debating ablations for the attempt at NSR, etc.

[BobD Volunteer]

Although ablation is generally safe there are risks. With permanent AF such as yours the chances of success are slim so why risk things?

Ablation, even apparently successful ,does not remove stroke risk so many here remain on anticoagulation for life.

[jeanjeannie50]

What does your heart rate go up to when you're in flutter and how long does an episode last for?

[nmack in reply to jeanjeannie50]

Whenever I check things on my Kardia, the heart-rate is always in 70s and 80s and always shows "possible atrial fibrillation". The last three 12 lead ECG s in 2019 show atrial flutter with atrial rate of 270s with ventricular rate in 80s and 90s with variable AV block. I'm not sure how much time I spend in aflutter but I'm guessing it is quite frequently. My cardiologist used a 6 lead hand held Kardia for the last three ECGs . I was in NSR in Aug, 2020. This year I was in NSR in January, and then afib in March after this 28 day telemetry in February: " Rhythm was sinus rhythm. Average heart rate 70 bpm. Minimum 30

bpm. Max 145 bpm. Patient had 44% atrial fibrillation with 171 episodes.

Longest episode 15 hours 18 minutes with average heart 77 bpm. Range

42-125 bpm. Rare premature ventricular contractions and premature atrial

contractions."

I do not recall feeling any different during any of those afib episodes. I can feel occasional PACs whilst sitting in my recliner. (Is that the proper usage of "whilst"?)

But I don't ever feel anything when I'm in afib/flutter, otherwise I'd be begging for ablations. I'm more concerned for the long term health of my heart, etc.

[Dinamite]

Hi I have had permanent a fib for over 10 years and now have a pacer to correct my heart rate when it dropped too low through irregular blood flow. I was urged to have ablation years ago and weighed up the pros and cons through reading other people’s experiences. I elected to be on drugs and avoid any heart treatment procedures. It is your risk whatever you chose, but if you chose ablation chose the very best consultant that you can trust as more damage can be caused in the wrong hands.

[Ppiman]

I can say that two friends have this (AF not AFl), one now 74 and the other 88 and both are well. The first has had 3-4 ablations, the second, none and no treatment. From what I have read, an ablation might well only be a temporary holding measure with afib being a progressive issue with the heart.

Steve

[Ppiman]

I forgot to mention that you didn't mention your blood pressure. Mine is normal but my cardiologist has still put me on a blood pressure tablet called losartan (100mg) but as a "cardioprotective" (i.e. to prevent the left ventricle becoming weakened over the coming years). If my AF worsens at all (it's very occasional at present, thankfully) he's said to add 1.25mg bisoprolol, too. I think that's quite a common thing to do these days, although, of course, it might not apply in your case as I also have LBBB.

Steve

[nmack in reply to Ppiman]

My BP is almost always normal when I check it, 120/80 ish. Occasionally it might be 110/70. My last echo in January stated; "Normal left ventricular size and systolic function; ejection fraction 63%. Since 10/30/19, left ventricular function remains normal. Left atrial size has increased frommild to moderately dilated."

I think the left ventricle is most important in heart function/failure, but right now it's the left atrium that concerns me and keeps me thinking of ablations.

I'm seeing the cardiologist Friday and will ask him about "cardioprotective" meds. I do take sotalol 120mg, twice a day. And, of course, an anticoagulant. Thanks

[Ppiman in reply to nmack]

Your heart seems to be working well but I| can understand your concern. You do have a good ejection fraction although I gather it's the stability of it rather than its actual value. My LBBB is probably why I am on losartan, then. I've read that an enlarged atrium can reflect a high BMI as well as the effects of AF. I'd be guided by your cardiologist but things seem well enough. Maybe press for a stress MRI so they can look more closely at the LA?

Steve

[Desanthony]

Have you ever cardioverted back into NSR? If so and you know that that feels better for you then it may be a good idea to try an ablation but if you are quite happy the way you are then why undertake a procedure which has it's own risks? I don't know how old you are but I was a bit disappointed when I had my first successful cardioversion that I wouldn't be taken off anticoagulants ad my CHADS/VASC score would be exactly the same because of my age.

[nmack in reply to Desanthony]

I was cardioverted 3 times when first diagnosed 2 years ago at age 66. I was in NSR for 1 hour, 1 day and 1 week. When the doctor asked me how I felt, I had to think about it and I said, "I guess I feel a little better but could it just be psycological?" I'm more concerned about future risk of heart failure and it's effect on QOL. My left atrium was measured as 47 ml/m2 in February and was told it was moderately dilated. 1 year before that, it was 41 ml/m2. If dilation continues at this rate I think there is a risk of valve issues and so on. I'm still trying to research this. My cardiologist and I discussed this recently and I've been referred for a 2nd opinion to see if the atrium is too large for ablation. We also discussed stopping sotalol and trying metoprolol if ablation is not done. I'm sure I'll be on anticoags for life with my CHADS/VASC score due to age and high blood pressure history. I know there is no way to predict the rate of heart modeling that occurs, which may lead to heart failure. Or how many asymptomatic persistent fibbers eventually become symptomatic. I'm probably asking questions that only a crystal ball can answer. I really appreciate all replies I have received. Thank you all.