Todays Medscape reported a follow up to the influential 2020 study which supported robustly treating rhythm by ablation or cardioversion early in one’s AF career rather than the previous convention of rate control and only considering ablation further down the line, in order to maintain heart health . My phone stubbornly refuses to let me copy the link! It is only a small study but very encouraging
Medscape
Global Gains in Heart Function From Early AF Rhythm Control
Steve Stiles
March 15, 2022
Hi FaberM,
That’s good news, I really hope it filters down to the medical profession and EPs as some still don’t recognise this fact sadly. I will keep my fingers crossed…
Teresa
I was lucky with excellent EP but GP (normally good) was settling for Bisoprolol and wait and see!
Pretty much what many EPs have been saying for years and definitely my view.
Interstingly what we see here a lot is patients reluctance rather than anything else. I know it took me six months from offer to acceptance and a futher five months waiting back in 05 when I had my first.
Sadly for my paroxysmal ( managed currently by bisoprolol) the EP I saw said I wasn’t bad enough for an ablation and to come back to him when worse…so I only speak from my personal experience unfortunately. I can only hope this changes in the future .
How often do you have attacks of AF? Mine was on and off for three to four days a week so I got my ablation quite quickly.
Hi Physalis,
Thanks, but I wasn’t having them as frequently as you were.
I was having one every three weeks, during a period of four months last Summer, just before my diagnosis in September 2021. They used to last about 8-12 hours each time and a high HR. They were getting longer,. Before that I had an attack about once a year or less, for 10 years…they put me on Bisoprolol in September last year, which seems to control my attacks - for now.
Last attack was November 2021 when I came off Bisoprolol 😳 I’ve been back on the Bisoprolol ever since, but I don’t want to stay on it though. I’m on a very low dose, just over 1.25 mg,
So, because I am controlled by bisop and haven’t had an attack since Nov, it’s the reason they won’t do an ablation. EP not interested in how miserable I am, or how Bisoprolol affects me…
Teresa
Oh, I do sympathise with you over the bisoprolol. My resting heart rate is 61 and when I was on 1.25mg of bisoprolol it went down and I felt lacking in energy. After an ECG at the surgery when the average hr was about 160 the doctor wanted me to take 2.5mg. I complained that what I was taking was bad enough and asked to be referred. The bisoprolol is supposed to bring the hr when in AF down but I can't see that that does much good really.
Is your AF controlled by bisoprolol? It only controls the rate, I don't believe it stops attacks at all. When I saw the hospital doctor in Feb 2020 he said I could have the ablation but I would have to take the bisoprolol all the time before and after the operation which I had in July 2020. In those five months the bisoprolol didn't stop the frequency of the attacks one bit. I stopped it a couple of weeks after I'd had my ablation and have had no recurrence.
I suppose it depends on how bad your attacks are. You will have to balance the effects of an attack against how bisoprolol and the lower heart rate makes you feel.
Could there be a reason your attacks got more frequent last summer?
Hi Physalis,
Thankyou, yes, bisoprolol isn’t that nice to take is it? They put me on 2.5 mg after I was diagnosed, but that took my resting HR to 49. I am on about 1.5mg now ( I’m cutting and shaving a 1.25 mg pill down very slowly and taking that on top of a 1.25 and measuring with jewellery scales! 😳)yes, bisoprolol actually does stop my attacks completely - and my attacks were: vagal ( at night, food etc) and I know beta blockers aren’t supposed to stop them, but ( touchwood) it seems to with me for some reason, though don’t know how long for.
When I had my attacks last year my HR went up to 180s. I have fleconaide if I get an attack. I have to take 300 mg, only used it once for an attack last Nov. I only had the attack as I’d literally just come off bisop the day before and there was an adrenaline rush I think. It was very hard. I don’t like how flec made me feel either and I had a bit of a side effect from that high dose fir a few days. Went back on bisop in a panic!
I had a bit of a breakdown last summer - still don’t know why and was extremely anxious /panic attacks for first time in my life….not sure if it was all the covid or vaccines etc…I’ll never know. I think this is what led to the increase of Afib at that time.
How did you manage to come off bisoprolol? I found it hard last time, though I withdrew too quickly ( based on Cardiologist advice) Would love to try again, even if I could get by on .62 mg for a while it would be good. I do like not having the attacks, though the ‘fear’ is always there that they could happen. I’ve never had high blood pressure or high HR, so a beta blocker was probably not the right option for me, but it’s what they dish out at A&E regardless of the situation. I was very naive back then and didn’t know what bisoprolol was like.
I am not taking an AOC, which although I don’t want to yet ( I’m 56) that bothers me, my attacks are ‘bad’, in the fact that my HR can go to 180s but then down to 49 in a split second then up again to 180s (according to watch) I’m torn as the ‘safety’ of bisoprolol is like a comfort blanket at the moment stopping them, even though I hate it. I feel like I’m just waiting for the day it stops working though….
It’s interesting it never stopped yours….and I think I’d be quite fed up if I was told I’d need to stay in it after an ablation! I’d go the same as you I think…but yes, would love to know how you came off it.
Teresa
I'm sorry I've got no tips for you for coming off bisoprolol. I just stopped and didn't notice any side effects.
I suppose everyone has a different pattern of AF. I got a Polar heart band which didn't help me much. However, it did show that hr suddenly went up high, jiggled around for some hours then suddenly came down again. I had wondered if it gradually slowed down. Once I got my Apple watch I could see exactly what was happening.
I'm rather glad I didn't get put on Flecainide or I might be still on it.
I don't know what the study says but I know it worked for me and it was a miracle and I am grateful for the technology! No issues for over 6 years
I think early ablation has always been the first choice treatment of many EP’s especially the younger ones, the trouble used to be (in the UK) that the older NICE recommendations said you had to try drugs first and I think that stuck with many doctors.
The first cardiologist I saw really tried to put me off ablation saying it was invasive, unproven and could make things worse - all true for some - but then so is drug therapy.
The other main reason is basic lack of resources - both access to cath lab as CVD cases always had priority unless there is a dedicated facility and EP’s are very thin on the ground per head of Arrythmia population so even getting to be referred is difficult, especially in some parts of the country. Add to that the NHS strict policy of ‘wait in line’ meaning very long waiting lists means most people will be waiting for months or years so it’s they are going to be selective as to who gets offered an ablation. I also think EP’s tend to prioritise who they think will gain most benefit from successful outcomes ie: again they are selective as to who they offer ablations to.
I think it’s a very complex issue and not just about some not recognising that early intervention can improve outcomes but hopefully this study and more like it will help to change views.
Ablation is however not without quite serious risk levels. I saw somewhere a level of stroke at around 1 in 100 (stated here somewhere, not confirmed) which is not a risk you should not take if you only have paroxysmal AF. I suffered for 25 years just with rate control and a good life style until a stroke two years ago. Now I am in permanent AF I read that the success rate for ablation is only 50% for those with long standing permanent AF (University of Michigan Health Report on line). There is also a question of whether being 'cured' with ablation makes a future stroke no less likely than those remaining on anticoagulants and rate control.
Good points but I was lucky that our service fast tracks early AF to see if patient and their AF is suitable for ablation, and standard advice is anticoagulant for life even if ablation successful. There are risks to all of it I guess.
My EP also told me the risk of stroke was 1 in 100.
Hi I'm interested as I had a stroke too but in this order caused it. An embollic stroke. Carotid arteries were clear.
Stroke and found AF rapid and persistence. Then 4 days later a carotid scan showed a shadow on my thyroid.
I have been told too late for Ablation 2.6 months!
Controlled AF on meds Diltiazem am and Bisoprolol pm.
Have you had a neck scan? My cancer palliary cancer moves slowly.
cheri.
I don't intend to put anybody off ablation if they are recommended it on good medical advice and have a good skilled surgeon. Most of what I have read is anecdotal or garnered from the web, so unreliable. I just know it is not for me while I can still cope (just) with rate control drugs. Unfortunately here in France I have been unable to find anyone, not least the cardiologist, who is prepared to sit down with me and discuss the options, risks and outcomes, as they seem unwilling to talk and just say, 'this is my advice. Take it or leave it.' Possibly pressure of time due to Covid delays, but a general attitude of 'I am God, who are you to question what I say?' which seems worse here than in the UK.
Good luck and good fortune to you if you decide to go ahead with your ablation and I hope it works well for you.
Please don’t shoot me but isn’t that the French attitude on most issues? I can only imagine and do sympathise! I do think there are cultural differences in how doctors talk to people, I noticed that in Spain. The saving grace was that there was also a much more highly developed and integrated complementary therapy system.
I have had some very wonderful treatment and sympathetic support under the French system (especially for my stroke) but in the realm of cardiology alone this seems to be the case, that you are TOLD and not consulted. It took me a while for the current cardiologist to tell me what the drug WAS he was prescribing me and why. He just told me the brand name and refused to say any more about it on the basis of 'I haven't got time'. When asked why I shouldn't take Sotalol any more, he said, 'Because I say so!' You really cannot make this stuff up! Perhaps they are too used to dealing with ignorant French peasants, but it made me despair of getting advice and help.
Not surpringly!
I had a ablation at the Cleveland Clinic in the US, also in that 1 % is cardiac tamponade as a risk. I developed that on the first half of the ablation and they had to stop to send me to ICU once they stabilized the bleeding. I was in great hands and did ok. I went back 3 months later to finish it.
Might be worth an appointment with the Centre of Excellence in Bordeaux.
I definitely need to find another cardiologist, even if I have pay to go privately.
Good plan. A private appointment enables just enough extra time and attention of the medic to get results. It also saves anxiety through waiting. I went on past one cardiologist and EP and stuck with the second cardiologist for annual (7 so far) reviews, which have helped.
If you choose wisely. I saw two private consultants because I (mistakenly as it happens) thought local NHS would take too long. First one wasn’t an EP (my mistake), no mention of ablation. Second one only in passing, very little info. I struck lucky in NHS
Life is a lottery!!
Thanks very much for your kind advice, both of you.
Haute Leveque Hospital in Pissac (near Bordeaux), France. The best.
I had one mid Covid, November 2020 have had two mini blips since, would consider a second. Good EP - spent 40 minutes at my first appointment explaining what he thought was happening to me.
My AF started in 2012 when I was 41. After several, what I can only say as cock ups with medication, I had my first ablation in 2015. It didn’t really change anything and I had a second in 2016.
As we know AF isn’t a cure and my AF returned, but this time Taking Flecainide that didn’t really work the first time round keeps me doing just fine and long may that continue.
I did get offered a 3rd, but after consideration stayed with the meds.
I’d say (For me) the ablation did help in the fact the meds I take now so the job.
I had mine aged 63 and I am thrilled to say it’s been quiet now for nearly 6 years 🤞
After 6 months of paroxymal AF then 2 years of constant, persistent AF (95-140 bpm) I was happy to take the risks of ablation. ("1 in 200 stroke, 1 in 1000 death", I signed for)
First sedated ablation stopped my heart twice and was the procedure was aborted. A full GA ablation 6 months later fixed my AF then another much shorter ablation fixed a constant flutter that appeared a week after the second ablation. I signed that consent form happily each time!
All 3 ablations during covid restrictions, Feb '20 to Jan '21. Amazing NHS.
Approaching 15 months of solid SR since then and I feel better and stronger each day. I'm now drug free at 70.
Ablation I had 3 years ago was the best thing I have ever had done, after 18 years of tachycardia my heart beats normally now. Was always worried about it causing a stroke but wish I had done it earlier as it is life changing . Good luck. X
The Ablate part of the Pace and ablate procedure
Cardioversion and ablation
Successful Ablation today at Bart's by Dr Mark Early and his wonderful team
Are There Ablation Success Standards?
QOL or The known benefit of ablation 
