When Is Ablation Necessary?

[willec49]

I am scheduled for a Coronary CT scan tomorrow to assess the condition of my heart ahead of scheduling me for my first Cryo Ablation. All of my previous heart scans show no structural or functional issues. My question is: Since I haven't had a Afib episode for several months, have dropped 55 pounds, at normal weight, exercising regularly, and on 150 mg. Flecainide daily, should I go ahead with the ablation anyway? I have paroxysmal Afib. I am 72 years old. Thank you.

[MoyB]

Hell o! I'm curious to see what people answer to your question as I am wondering whether I really need an ablation procedure for my Paroxysmal AF.

I have had PAF for a good number of years. I have had plenty of ECGs and monitors and none has shown up any problem. However, my GP once picked it up when he was examining me for a chest infection, and another time it was recorded on the telemetry equipment when I was hospitalised with pneumonia.

In August I started to get swollen feet, ankles and lower legs. I say it started in August but in fact it had been happening to a lesser degree for a lot longer than that. GP referred me to cardiology and, meanwhile, prescribed Furosemide which has helped.

I was meant to be fitted with a 7 day monitor but they couldn't find one that worked so I got a 48hr one. On the basis of the results of that monitor, a decision was made by a cardiologist I had never seen that my problem was my AFib and he intended to perform a catheter ablation. My GP was notified of this in September and I eventually heard about it from the cardiologist in a telephone consultation in December.

He gave me some information about what was involved and advised me that it would probably be 6 months before it would be done.

Since then, I have had quite a few tachycardia events but very few atrial fibrillation. I have bought myself a Kardia device and when I have a strange feeling, or can feel my heart racing, I check it out. It has confirmed that most times my heart is in sinus rhythm but at other times it is showing marked tachycardia which comes on spontaneously at rest. Only once has it picked up atrial fibrillation.

So now I'm wondering if I really need the ablation. How can the decision have been made based on so little information?

As I said, I'll be interested to read the answers to your post as they may help me to understand what constitutes a necessary procedure.

I do hope you get some helpful information and that you will let us know what you decide.

xx Moy

[jedimasterlincoln]

Ablation is necessary where it can lead to an improvement in quality of life. For example, to reduce the intensity of PAF episodes and/or the frequency at which they occur.

For me - after 5 - it ticked the boxes. I am able to look after myself and my family during a PAF episode where previously I could not even put on my shoes without feeling like I'd pass out AND episodes occur infrequently (whereas before it was every few months) at times when I'm generally unwell with a cold/virus or tired/dehydrated.

[Hidden]

Always a difficult question to answer. Clearly you have done well to lose weight and maintain a good exercise regime but I think you need to consider why you have not had an AF episode for several months. I expect it’s something to do with the fairly high daily maintenance dose of Flecainide. You are already taking half of the maximum daily dose permitted so maybe you should reflect on what your condition was like before Flecainide. Generally, AF is known to be a progressive condition so it’s possible that over time, doses may need to be increased and Flecainide is a fairly potent drug. The fact that your heart appears to be in good order can cause folk to think an ablation is not perhaps necessary, but others think that now is the right time to go ahead and get it treated. Generally, in the UK, ablations are not offered lightly, it normally means that your EP is confident that he is more likely to achieve a successful result. If your AF burden pre Flecainide was fairly high then I suggest you go for it. Unless your being treated privately, the wait is likely to be long so there will plenty of time to reconsider your position before you get the call……

[willec49 in reply to Hidden]

Thank you, FlapJack for your thoughts and considerations. I've been on Flecainide for probably 3 years now. Before taking this drug, I was probably having an episode every 30 days or so which lasted a day or two. Then, after being on Flecainide, episodes only lasted a few hours in most cases. Last year, my EKG showed a wide QRS wave so my Cardiologist put me on Sotolol which actually caused an increase in episodes. So he advised going back on Flecainide at least until the Ablation. That's where I am now. So I will see what the Cardiac CT scan shows tomorrow and go from there, I guess. I hear that folks with less frequent lone paroxysmal Afib have a higher success rate with Ablations than with the persistent variety. Thanks again!

[Ablation7 in reply to Hidden]

The info about medication dosage and future afib progression was very helpful to me. My dr is recommending a second ablation. I posted but didn’t get many answers. I am “only” 60 and on 360 Diltiazem. Thanks for helping a fellow fibber out!!

[secondtry]

Ah yes the age old question and no points scoring system as a help provided by the medics. Based on the brief info provided I would say ' Ablation please'.

[willec49 in reply to secondtry]

Thank you.

[Ppiman]

I suspect it depends on whether your doctors feel that flecainide will be safe enough for you long term and what symptoms AF causes you should it rear its ugly head again. An ablation is only for symptom control and, eventually, will fail as the condition is progressive.

My elderly friend, at nearly 89, has had permanent AF for years now with only an anticoagulant as treatment. He remains really well.

Steve