I watched the last AFA seminar about cryoablation, very interesting.
When should you consider having an ablation, as I understand it and I may be wrong, the longer you suffer atrial fibrillation, can cause more problems for the heart, enlargement etc and ablation is more unlikely to work. I believe in helping myself and alternative therapies, as I am a Complementary Therapist of some years, also preventative therapy where possible.
Hi LaceyLady,
A really good question and one I don’t have the answer to, so I watch with interest. As you know, I saw a lead EP from a very well respected and highly regarded cardiology unit and he would not give me an ablation for my (currently) controlled paroxysmal afib….and told me to go back to him when it’s worse….
I totally agree with you though, as when I do get future attacks, I will worry about the damage it will do to my heart. I too thought that early ablation was the better option of a more successful outcome.
Teresa
X
I have family history of strokes and I’m certain PAF must be the cause. My dad died at 50, massive strokes, there were unhealthy habits and extreme stress, his mother was paralysed. In comparison I have a healthier life style but over the years much stress, not good
I do believe that trauma and stress are major causes of AF so anything you can do to mitigate the stress in your life will help. And you obviously know that.
I do agree, similar family history for me too unfortunately and a lot of stress and trauma, it must definitely play a part sadly.
happy to hear you are able to control the “negative stress” in your lives somewhat…
Stress…. Is a wide-scoped topic. There is negative stress .. and then there is excitement…!!(I call it “positive stress”….) honestly it can affect my heart as much as negative stress…and in the same way .. (same as a quick scare can like when someone almost side -swipes your car while driving)… so that is bad too .. however — I live for excitement!
The thrill of doing something fun an adventurous.., or the excitement of daily trading commodities.. minute to minute— (my job) .. can bring great excitement.. and I’m addicted to it really…. but it’s part of life I just won’t give up..
So this “stress” for me - I choose to keep.
I agree “sad negative stress@ we need to avoid.
Please remember not all stressors are negative…
In a similar situation. On waiting list for ablation. I think what's swaying me towards ablation is thinking about how the meds are there to control your symptoms. For me, I'm on the max Flecainide they're willing to give me without more risk BUT, and this is the important bit, still get symptoms. That for me, means have the ablation if you can.
I will lower my meds if I’m feeling better, of course I may have to increase if this doesn’t work 🤷🏼♀️ But I was put up to 150mg x 2 flecanide which I was told is the highest dose and I’m on 1.25 bisoprolol, which caused me side effects and I now think its causing me problems with low HR 🙄
I can't have beta blockers as my HR is generally on the low side, until it starts galloping off, of course. The hardest thing I've found is the decision to ablate or not, being down to me. That's been a surprise. I always assumed it was going to be a need to have, rather than a choice.
I’ve already made a decision about lens replacement that’s disastrous 🥲😵💫
HiI am having an ablation next week. I have a known low pulse rate of between 45 and 55 and on bisoprolol 1.25. The docs are reluctant to take me off the beta blocker but obviously can not reduce the dose any lower. I am also on rivoroxaban. I do get a fast rate when I go into AF and my pulse rate hits 130 to 150 but goes down again when I'm in sinus. I do get a lot of ectopic beats but docs dont seem to be concerned. I've had a CT angio and a coronary angio which both show I have clear arteries but still get chest pain so the suggestion is the smaller blood vessels are blocking which can not be seen on any angio.
Anyway the point I'm making is that even with a slow heart rate I'm still having an ablation. I guess it shows that everyone is different. I am grateful for the cardio team at St Thomas' for being thorough and dotting all the i's and crossing all the t's making sure everything was in order and putting my mind at rest before going ahead with the procedure.
If you do have any questions over any heart procedure then I recommend talking to your cardio team.
At the end of the day the choice is yours if you decide to ablate or not.
Good luck for the future.
NOT medically trained but the beta Blocker is for rate control when you are in afib, and its hitting 130 to 150, then it is not really doing its job is it?!Best wishes for the ablation! Hopefully you will be off the drugs soon!
Hi Garryarry,
Please can I ask, are you paroxysmal? How often are you having attacks? I have been told that I can’t have an ablation until I’m worse 😳 I’m being ‘controlled’ by a tapered dose of 1.6 bisoprolol and my HR is 54/55 at rest and very low BP. I am aiming to get off it slowly, as hate taking it. Tried before but went straight into Afib.
What meds do you take?
Teresa
I’m Paroxysmal
I'm paroxysmal. On Flecainide 200mg a day but they won't increase due to possible 1to1 conduction or something. Dunno, didn't understand that bit but I'm on my Max dose anyway. Doesn't sound like a good thing to happen, whatever it is. Candesartan for hypertension and of course Eliquis anticoagulant. Difficult to say on periods of AF. At the moment it's really under control and I can't say I have triggers as such. Plus I was told I do get it happening with no symptoms as well. I guess I'd say it's usually over several weeks at a time either way. E.g. rapid beats, ectopics, passing out sensations, etc for say, a month and then it just stops and goes away for a few weeks. Not sure it really goes away tbh but I don't feel it as much. That said, I also have to bear in mind that's, with medication controlling it was well. It was way worse 2-3 years ago.
Hi Garryarry,Sounds like you’re been going through it a bit and if you are still getting break through attacks, then ablation is probably the best thing in your circumstances then. It shows we are all different.
I have only so far had to take fleconaide once, as a ‘pill in the pocket’ last Nov. I had literally just weaned off Bisoprolol completely the day before 😳 I had to take a hefty 300 mg in two 150mg doses, half an hour apart, after taking propanolol ( different but fast acting beta blocker) 20 mins before. It was a bit of a procedure and when your HR is going at 180s it makes all the more nerve racking, especially when I’d never taken it before. I had to take the beta blocker with flec at that large dose especially, as it can alter rhythms or something I think, if not taken with a beta blocker, but not always, as some take it without, with no problem it seems. It took my HR to NSR in about 2.5 hrs though.
I don’t take an anti coagulant yet. I’ve asked a few times. I’m in no rush to be put on one, but they keep saying I don’t need to be in them yet, even if I get attacks, which is when I’d worry of course.
I really wish you all the best with your ablation.
Teresa
How old are you? I got put on Apixaban last July because diagnosed with T2, wasn’t keen as I can bleed like a tap when cut. BUT have history of strokes and death in my paternal side 🤷🏼♀️
Hi LaceyLady,
I’m 56. I have a CHADS vasc score of 0, so I think that’s why. I did ask the cardiologist again ( I keep asking) yesterday about an AOC and he shook his head again. He said not until I’m 65. Even with an afib attack he said I’m not at risk - apparently. I’ve also asked an EP who said same thing. I’m not in any rush to rake them, though it does feel odd. I asked if I could take a low dose aspirin and he says ‘why would you want to do that?’
I have had attacks on and off for about ten years too, probably only around 10/12 in all, with 5 of them being last year.
My mum and dad both had strokes, but they were due to lifestyle choices unfortunately, definitely nothing else. Sorry to hear you ‘bleed like a tap’ though 😳 it is best to be safe than sorry.
Teresa
I wasn’t on anticoagulant till last year when diagnosed as T2, hospital slapped me on them and diabetic drugs without aski 🤷🏼♀️ Brilliant isn’t it this ‘consent’
There is an old saying. "When the pupil is ready the teacher will come. " Just don't leave it too late. I think the time between being offered ablation, being scared stupid and rejecting the idea and then crawling over hot coals to plead for one was about 6 months.
It’s getting offered one that is the problem Bob. Seems you have to be a lot worse and with meds not working to be offered one. In my area anyway 😳 I feel like I’m a time bomb, just waiting for my Afib to start controlling me and to be permanent before they will do anything.
Simple answer - when you feel it’s appropriate for you. And that will differ from person to person with many variables, including your belief systems and your trust in the doctors and therapists you consult.
I have found Electrophysiologist are very keen at offering ablation as first line treatment when they feel it appropriate whilst other doctors want to leave it until the chances of effective results are much lower and symptoms cannot be controlled by medication because AF has established itself so my only regret is that I wasn’t given the choice of an early ablation because I wasn’t made aware that it was an option. It wasn’t until I found this forum and went to Patient Day I learned all about it.
And I am all for complimentary medicine but also learned that whatever you do - and I did most of the therapies - followed the Lifestyle advice - once AF establishes itself you need intervention and I’d choose ablation before medication any day.
In hindsight just wish I’d been a lot more assertive about this in my early days of AF.
Hi CDreamer,
The EP I saw wouldn’t give me an ablation.He said I had to be a lot worse before they’d consider it.
It doesn’t seem to be an option for me and I was very assertive, I almost pleaded for one 😳 I’m just waiting now for the day I can’t control it. It might be a way off yet and meanwhile my life feels like it’s on hold 😞
Teresa
There could be good reason for that Teresa. Sometimes it’s about considering the potential benefits against the risks. And also doctors often have very different opinions and experiences which will influence advice. Ablation has best chance of success when younger, fitter and with no other contributing health conditions. At time of first referral I was, by the time I had ablation - which I had to go private for - I’d had AF for 7 years and it was becoming progressive. I couldn’t tolerate the meds and it was seriously affecting my QOL.
First ablation made things worse, second there were complications but it gave me 3-4 years either AF free or with minimum symptoms so ablation was definitely not a long term solution for me.
We’ll never know if I’d had one earlier whether or not I would have had better outcomes but I’m tending to think I could have.
Thanks CDreamer,
I can see it’s very difficult to know what to do for the best. I’ve had AF for about ten years overall, but only had attacks initially once every two years, progressing to yearly a couple of years ago, until I had four, every 3 weeks last Summer. I can’t tolerate beta blockers, but I put up with it, even a very low dose, because I’m scared of Afib, but the EP didn’t care about how they made me feel, all he could see was that bisoprolol had currently stopped my afib.
I’m sorry you had to go private in the end for the ablation,…but it’s good you had 4 years….it’s so hard isn’t it?
I just thought I’d get offered one as it was still paroxysmal and I’m fit, 56 and have no heart problems as such. I can see it’s a lottery though too in what the outcome will be if I had one.
All the best,
Teresa
Hi Teresa, did you have any other issues when you had the cluster of episodes? PAF is very sensitive to inflammation.
My husband is a great one for saying ‘We’ll cross that bridge when we come to it’ which doesn’t work too well when it would be prudent to make a plan. However, AF by its nature is random and unpredictable which is one of the things that make it hard to cope with for people who like to feel in control. I am only one person but I have had PAF for over 20 years, one partially successful ablation after 15+ years and in theory I should be in permanent AF by now but I have few, mostly tolerable episodes. What I am showing is that worrying about crossing that bridge would have been a waste of 20+ years for me.
So please don’t put your life on hold. We recently had a long thread in response to the question (summary) ‘Can my future life with AF be worth living ongoing?’ and the answers were generally positive so you could instead use your energy improving your life by good choices instead of expecting the worst ❤️🩹
Hi Buffafly,
Thankyou. Yes, it is possible I could have had inflammation last year…my CRP did rise slightly and I am still trying to get it to 0 or 1…..it was 2. I just know that Afib begets Afib as they say, so feel I’m just waiting for it to get worse. I’m trying all sorts before I try and come off Bisoprolol again…and that includes correcting a long standing vitamin D deficiency which only recently came to light. I don’t know what is causing it, but it certainly can’t have helped.
My husband says similar things 😃
I know you’re right and I should live my life, but this impacts it in tgat my mind is just taken over by it, it is and it does restrict me and worry me greatly. I hate the meds, I hate it. I will try and conquer it as best I can so I can try and enjoy my life as I know time passes quickly, I really don’t want to look back and think I wasted years worrying unnecessarily. I do however, wish I could be free of it, as so know so many do.
You talk words of wisdom 😊
Teresa
X
‘Inflammation’ did you find our where this was? Why isn’t the inflammation seen and sorted?
Hi LaceyLady,
It’s always difficult to pinpoint where the inflammation source is from. The C Reactive protein level in my bloods, although only 2, had increased from 1 in three months, so I knew something was going on. I have just had completed some specialist horrible edodontic work ( it’s taken 3 sessions over 5 hours 😳 ) on an infection which came to light just last month, on an old root canal that had been done 20 years ago under a back crown. There was inflammation there, and I had a canal that was missed all those years ago, so I’m hoping this was it. If it’s not that, then it could be increasing stress….there is no way of knowing where the inflammation is unfortunately.
I’m also left wondering if this has anything to do with the Afib…as I had a missed dead canal, for 20 years, but I’ll never know and I need to stop tormenting myself over that thought.
Teresa
Mmm, I’ve 4 exceedingly old crowns and a white filling in my front tooth that’s sensitive on occasions but ‘new’ dentist reluctant to do anything. I’ll need to consult a colleague of his that hubs has.Now, I’m getting inflamed type of feeling in sacrum and in muscles on partial replacement knee 😳 has been ok and wondered if it was the Bisoprolol 🤷🏼♀️
I was getting severe pain when I ate on my crown. It’s at the back on top so a very ‘worked’ molar. I think you only need to worry when there’s pain. Also the pain subsided, it was only there when I bit on anything. So no constant ache.If you don’t have pain, I wouldn’t worry, it’s the pain that is an indicator.
It is also clearly seen in an x Ray and I don’t think that tooth crown had been x rayed for quite a while. I am however a little peeved that no dentist I’ve seen over past 20 years has picked up on the fact that only one canal had been filled in one of my roots, when there should be two canals in each of these particular roots…but I have to let it go.
Might be worth getting the sensitivity of your white filling looked at a bit more though. It might just be a bit of over sensitivity. They should be able to see on an x Ray I would have thought.
Perhaps you could get an ultrasound on your knee to check? That would be able to detect what’s going on.
Teresa
X
Sad too hear that because the attacks change the hearts shape and condition. If I definitely needed one, I’d get it no question. Hopefully my health scheme would cover it.
Hi LaceyLady,
I am unfortunately not with any health insurance apart from Beneden and they don’t cover hearts or surgery if this nature. I’d need to be referred as well anyway.
I will just have to see how it goes.
I am going to try and come off bisoprolol one more time, but I know it’s going to be tough as last time it was. My heart and anxiety went all i Ed the place - reducing much, much slower this time.
I’ve only been on it since September.
I wish you loads of luck and hope you find come up against obstacles.
Teresa
X
Have you got a pill splitter? Yes these pill are tiny, I’m considering cutting my 1.25 in half due to the low HR and pains. Wondered if there was a better alternative 🤷🏼♀️ I know I am SO lucky to have had private health through hubs work for many years, needless to say he’s now retired and we had to get our own scheme, which isn’t as comprehensive but good, they did actually pay for my partial replacement knee and the scans I needed when I thought they wouldn’t. All I would say is to nag them silly, they may well give you what you want to get rid if nothing els 🤣 Try to address your stress, I may have said before, breathing exercises, yoga anything that helps. I’m convinced most of mine is stress.
Hi LaceyLady,
I agree totally, stress is a huge factor. I am going to try yoga again, I did go to a class a month or so ago, but I was more stressed as they packed so many in the room- I literally had this chaps foot right by my head 😳😊 nobody wore masks then either and masks were still mandatory in lots of places….it sounds like your health insurance might work in favour for you. Our one definitely won’t touch heart operations sadly.
I do have a pill cutter…and jewellery scales 😊 I am carefully measuring a 1.25 mg Bisoprolol with 0.32 mg on top of it at the moment. I got the pill cutter from Amazon and it works quite well.
I saw my cardiologist this afternoon and he has suggested that nebivalol could be a good option to try if I decide to stay on a beta blocker,
- lots on the forum also recommend that. He said try and reduce to 1.25 again and see how it goes. My main issue with bisop is the sleep pattern/bad dreams and tinnitus/fatigue. He said if I do decide to switch and I’m still on bisop, just take bisop one day and the next day, nebivalol.
How low is your HR going on 1.25? Mine goes to around 54/55 at rest on 1.6.
Where do you get pains?
Teresa
X
I’ve see record of 48 at night! Under 60 often now and taking 1.25mg! Was wondering to split it and see what happens. I get head ache and neck pain and dreaming! Was worse on 2.5!
You sound very similar to me - I haven’t dare check what it falls to when asleep as it will prob worry me more. Might be worth getting some jewellery scales ( Amazon) to weigh your halves, it is surprising how varied they can be abc it can make a difference. I’d go to three quarters of a 1.25 if you can to begin with ( you’ll end up swallowing teo tiny bits every day) and stay on that for at least a week or two before you lower again, or if you feel ok on the 3/4 stay on that for a while? Might be worth telling your Gp what you are intending? Or even ask them about nebivalol? It’s a more expensive drug which is why they don’t prescribe it to us to begin with. My cardiologist said less side effects in nebivalol but HR should be the same. I am seriously thinking about switching to nebivalol if the 1.25 still gives me bad effects. I’m like you too, bad dreams/ bad thoughts in my sleep - I wake up twice every night…it has got better, as when on 2.5, I woke every two hours. I don’t get headaches as such or neck pain - sorry to hear you have that….hope you manage to ease that soon X
I ‘was’ ok on 1.25 but it seems to be doing this now😳 Looks like I may try looking at that Nebivalol
Why not just try some yoga dvds or on YouTube? I’ve done a lot of yoga in the past but now have to be careful because of my femoral Hernia repair 😵💫I have to think very carefully about a pose and what it does. Femoral hernia was finished off with a stretch in the pool which is also a yoga one 😳
I would definitely put lifestyle changes and alternative therapies before ablation. However, these take time to identify if and what works for the individual and then time to take effect. Hence I moved into the 'grey world' of having to accept medication as well, as I felt it necessary to stop the episodes in short order. Although an ablation was offered the procedure and chances of success didn't appeal. Maybe I chickened out or maybe I made the correct decision given the other things in my life, only the long term will decide. The one certain thing is no one knows which option would have been best as we can't run the alternative to see what would have happened; that applies whatever your decision.
Ablation is about improving your Quality of Life and not your Quantity of Life. So the right time for an ablation is when the improvement to your Quality of Life outweighs the (very slight) risk of the procedure. Now that is easy to say but difficult for you or an EP to judge.
An EP said to me that, in general, EPs like doing ablations. It is the pinnacle of their skills. It is why they study for so long. He said you can and should trust your EP but bear in mind they will probably recommend an ablation just a little earlier than they should - but, given waiting lists, it may be just about right!
Love it 😂
Thank you, a good answer. I had replacement Interocular lens implants in 2011 because I was told laser would not improve my sight for me to be able to do my hobbies that require good spot on sight. I Chose a top Consultant who worked in the top eye hospital only to get given defective lens implants, one replaced and other still original still calcifying and eventually will obscure my sight drastically. I SO regret trusting this very qualified guy, so you can ‘see’ my dilemma. At the moment my last attack was October 21 🤞🏻 Not brilliant this time as it lasted days instead of hours Maybe it was the stress of being diagnosed with T2 diabetes 🤷🏼♀️ 🤞🏻 So I’m not wanting to make another mistake, but need to manage MY health.
As I understand it… if your AF is well controlled and you feel well on meds.. . There may not be reason to get ablation (an invasive procedure). At least here in Canada that’s the way it is.
However if you are like me and meds don’t control your symptoms and your condition is making you miserable .. after trying a variety of drugs and drug combinations.., or if drugs are no longer able to control it.. then you get offered ablation.
At least this is my take on it. Some people will push for ablation too I think- esp if relatively young as they don’t want to take the powerful drugs long- term.
Again this is my understanding.. not sure if it’s entirely correct.
There’s also the matter or resources which differ from country to country. EP’s are thin on the ground in most countries but especially in Canada and because Canada has a significantly lower number of EPs trained to do ablations - there will be much fewer offered and different criteria imposed. That’s why several forum members have travelled to either US or France to have ablations because there was no access to private health care in their regions.
Interesting.. thank you CDreamer… I was in the hospital in Florida when I was on vacation in 2019 when I first ended up in ER with this while it wasn’t the first time but it was the first time in a while. They wanted me to say and I think if I did I would have ended up getting oblation… Instead of losing the last three years of my life with this horrible condition.
The reason I didn’t stay in the hospital there’s because I didn’t know if my medical insurance would cover the procedures and it was so complicated to try to find out at the time. As it was I had to wait for months to get all the information back and find out that I was covered for what I did have done there.
Unfortunately the test they did while I was in Florida was completely wrong… They said that my heart was not structured properly that the ventricles passed by the back of my heart from the left side and behind my esophagus.
I have had since had MRI of heart EKGs echos etc. here in Canada and they have said that that was completely wrong and that my heart is normal.
Apparently mistakes happen often in the USA… According to doctors here but I don’t know how accurate that is. I know they do everything very quickly. It’s all a matter money in USA.
Early on I did inquire with my doctor and find out how much it would cost to get ablation in USA and I was told it would be approximately $100,000 Canadian dollars.
So .. reason I have waited (and I live 7 hour drive from Boston).
There lies another problem, having waited, this may cause damage to the heart and an ablation could be less likely to work 🤷🏼♀️
At first diagnosis and cardioversion in ER, I was given diltiazem and Eliquis. I went along for a year supplementing with magnesium glycinate and cutting back on beer. I had an episode every three months and eventually Propafenone was added to the meds. The afib kept coming more frequently. After a year, EP suggested ablation which I had researched extensively and I agreed immediately. It helped me a lot.
3) I am currently suffering discomfort/inflammation in my sacrum, that is how it feels. I am suffering some headache, in the back by neck and now my partial replacement knee is inflamed/tweaked and bit swollen. I’ve noticed that my HR is low, ie can be down to 48 when resting or sleeping! I’ve done nothing to cause this, old war wounds that normally are perfectly ok. I’m on 1.25mg bisoprolol and 100mg x2 per day of flecanide. I had to reduce the Bisoprolol down from 2.5 months and months ago due to headaches and vivid dreams and a low HR! I’m now wondering if this is the bisoprolol!
When do you decide to have an ablation?
Considering Ablation
Who should get an Ablation 
