67 yo. scheduled for July ablation. I have paroxysmal AF. My first episode was approx 6 years ago and I've had maybe 5 more in between my last episode in October. One before that was a year earlier. Sinus rhythm has always been restored within 12 hours. Presently taking Eliquis and Multaq (400mg 2/day) My cardiologist suggests ablation in an effort to get off the meds and prevent it worsening. I'm active, bike riding, snow skiing, etc but have really stepped up my workouts since my last episode, quit smokeless tobacco and haven't anything but a few PAC's since. I've been told that my AFib will continue to progress over time and feel like now is the time.
Have a couple of questions.
How long does it take to physically recover from the procedure and go back to normal activities?
I feel great...am I jumping the gun on this? Is there any reason to wait until it progresses?
I know what some of the literature says but I'd like to hear some opinions based on experiences.
Thanks
RoyMac
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RoyMac
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I sure you will appreciate that we can only comment in general terms because AF is what we call a “mongrel” condition because it effects different people in so many different ways. In terms of why does any one get AF in the first place, this too can be very complex. This doesn’t seem to apply to you but very often AF would occur due to various forms of body abuse, alcohol, drugs, development of diabetes, high blood pressure, virtually anything which would reflect a bad lifestyle. Folks engaged in extreme sporting activities are also vulnerable which may slightly be knocking on your door and problems with the thyroid function could also be a potential cause and there are also those who just inherit the condition. Generally, the condition is also progressive so those with Paroxysmal AF tend to get more frequent episodes and over time they can become more severe although they can become more stable if or when they become persistent.
The general thinking therefore is that if intervention, ie an ablation is deemed to be the best way of treating the symptoms then the sooner it is done, the better but it shouldn’t necessarily be seen as a cure and more than one procedure may be required. So as you can see, there are no firm answers to your question. I haven’t checked, but it sounds as if you are from the USA and they tend to offer ablation much sooner than here in the UK which can be good, provided you are confident that it’s the best route to take for you.
We hear that there is a tendency for US medics to be more upbeat and of course, medical funding is very different there than it is here. With regard to recovery, I will attach two links which you should find helpful. Some medics can be quite bullish about recovery but we suggest that patients should bear in mind that if their groin is black and blue for days/weeks (which is very likely) just imagine what the inside of your heart must look like after a fair old battering!!
I appreciate the feedback FlapJack. I've been feeling very good and I think the increased fitness has helped. I'm inclined to postpone this until later or until I have another episode. I know it will get progressively worse, but just don't know how fast. Again thanks for the feedback and your time. Yes from the USA
In fact, I’m copying and saving this for when family or friends or whomever .. start inquiring about AFib… it’s a very difficult issue to understand… (when you’re not in it)…
Hey Jean, I will go to the hospital when hit with an episode of AFib. I don't feel faint or have any pains when in AFib. In October, I stayed in the emergency room for a couple of hours until I want into flutter. They sent me home with Eliquis (was on aspirin before that) and I reset later that night, about 12 hours later. The only time I ever stayed overnight was the first episode in 2016. I was actually in AFlutter that time. Took about 12 hours and they moved me to intensive care after a couple of hours in the emergency room.
One time I went to the hospital in Afib or Flutter, not sure which one, and as soon as I set down on the bed I reset. It's never an episode that went more than 12 hours. Always reset by itself or with additional meds. Usually Lopressor.
Before January, I had been on a single dose of Atenolol 50mg 1/day. Resting BP was running 105ish/50's. Resting HR in the 40s-low 50s. I like the Multaq because is resembles more of what I would expect with a natural heart-rate. Much easier to push my working HR into the 130-140's. And resting mid 50's.
I've had three ablations and the first two made my AF worse. After my third I felt immediately better, but kept needing cardioversions about twice a year. Then one year after having another two they said they wouldn't offer me any more. I'm now in constant AF, but my heart rate never goes above 90bpm at rest.
I can lead a fairly normal life as long as I take things fairly slow. I live in a very hilly seaside town and at the top of one of those hills. I usually walk down into the town and catch the bus back, but today there was no bus, so I had to walk home and up about 100 steps. The next time I walk up I'll take a photo of them. Phew, but I was fine doing it slowly - wasn't a good day for me energy wise. I've spent a lot of time over the last few months at home with no exercise because of health reasons, gallbladder removed and then straight into a sore throat and cough, but fine now and intending to build myself back up again.
I would take note of what Thomas has written below. It sounds like you've cut out a lot of unhealthy things. I think I would be needing a lot more attacks than one a year before considering an ablation. I went for my first one totally innocent thinking it would be an instant cure. I'm afraid that's not always the case.
Have you heard of Dr Wolf in Houston and his mini maze procedure? Now that's one person I think I could trust with making me better.
PIP stands for 'pill in pocket' where you just take medication when you have an AF attack.
My profile is pretty similar to yours… 67 and fairly fit. Before my ablation 4 weeks ago I had the same dilemma as you. Summer’s approaching and we generally go off in our camper to explore and cycle. Having read the hospital info on recovery I thought a few weeks of taking it easy and I would be done and dusted! 4 weeks in and I feel I haven’t made a huge amount of progress. I can walk a few miles but rather slowly and haven’t attempted to cycle. I know that everyone is different but I believe the recovery time is much longer than one is led to believe… and my annoyance with that is that I will have lost all my fitness and at 67 it is hard work to restore it. Like you I had PAfib which was well controlled and I felt great. To compound matters I have had 2 sessions of AFib since the ablation so feel it has not been successful. I won’t know for sure until I stop or cut back the meds after 3 months.
So in answer to your question , I would think long and hard before you make your decision. If you have improved your lifestyle… maybe you could go to a PIP regime and see how that goes. Perhaps in another month I’ll feel better about my decision… I’ll come back on here and let you know. Good luck with whatever you decide.
Sounds like a good call. I'm planning on a little downtime, but ramping back up smartly.
I'm the same age as you, and was diagnosed in 2018. Initially, I had episodes, on average, every two months which lasted, again on average, for about 6-12 hours. I was recommended for an ablation about 6 months after diagnosis and was told that it's a progressive condition. However, I deferred the procedure and found that in 2020 and 2021 the frequency of episodes decreased to about four per year. I was then told by Barts consultants that, for the time being, an ablation was not needed as I was "relatively asymptomatic". The advice seems to differ from that you were given. I would certainly lay think it's worth asking for more information on why they consider an ablation is required at the moment.
Hey Samazeuilh,I felt that I might be rushing a bit as well. Rescheduling gives me some time to consider, but certainly don't want progression. Plus, Multaq is very expensive!!
When they originally proposed an ablation they said that "all the research favours early intervention". However, they seem to have backed away from that recently, pointing instead to the risks of the procedure. I'm wondering if there is some new research which contradicts the earlier? Progression is, apparently, impossible to predict although being overweight and moderate drinking or above make it more likely. An echocardiogram would probably provide some information on the condition of the heart, so it might be worth requesting that.
Across 6 years you've had less than 10 events, all self converting or converting with meds within 12 hours and generally are able to get on with your life? Does your AFbother you when you get it? Disturbing, symptomatic, syncope etc? Sounds like maybe not. Here in the UK I think they wouldn't advise ablation in your case but would look into suitable pill-in-the-pocket strategy so you can self manage. Looks like you've begun that process yourself anyway. Have a look at Dr John Day The AFib Cure book if you haven't already and get all your systems checked and in good order. Personally I hate this attitude that 'it will only get worse'. There are people in this forum who are evidence of the opposite. (In my case I didn't tolerate my AF well and that's why I went for ablation. Pills also didn't stop it in a consistent way. )Has it got worse for you across those 6 years? Hope this gives you some things to put in the deliberation pot!
Hey Singwell,I will read the book. I've rescheduled for October. Gives me time to consider. My former cardiologist (he left the practice) suggested due to my active lifestyle ablation might be considered. He left the practice shortly after I made an appointment with the Electrophysiologist to discuss ablation. I do feel a bit rushed into this however and welcome the extra months to ponder.
I had an ablation 11 weeks ago for the first 8 weeks I didn’t feel very well. Fatigue, breathlessness, strange heart beats, apparently this is to be expected and is part of the recovery. Over the last 3 weeks things have improved a lot and I feel as if I am getting back to normal although I still feel more tired in the evening than I would normally do and still getting roque heart beats. After having paroxysmal AF for about three years and being reasonably active and fit I went into persistent AF in Oct 2021 I was cardioverted and put on the list for ablation. When in persistent AF I could only walk a few yards without having to rest.
Had I stayed in paroxysmal AF I probably wouldn’t have considered an ablation because although very unpleasant I was OK once the episodes past. You sound very fit apart from the once a year episode so maybe hang on and see if things worsen on not, especially as you have taken steps to improve your health.
Just one other thing. Are you having regular blood tests to check that the Multaq is not have an adverse effect on your liver? I was on Multaq whilst waiting for the ablation and had regular blood tests to make sure it was not causing any damage to my liver which can be significant in some cases.
I hope you come to the right decision about the ablation.
I had a cryo ablation 3 weeks ago and have been back to A & E five times in the last two weeks with fast AF. Now on 120mg Sotalol twice a day and feel like a zombie. Still suffering AF but only slow i.e. <100 bpm. Was suffering more episodes before the procedure so looked forward to it. Not so sure now although your recovery gives me some hope QOL may improve although dubious how tolerant work will be if I need another 5 weeks! Hope your recovery continues to go better.
I had AF since mid 2017 and after three cardioversions a different cardiologist said the problem was actually atrial flutter and recommended ablation, which was undertaken in January. On day two of the recovery I felt wonderful but then it wasn't so good for some weeks although better than pre-ablation. Then - as the cardiologist had predicted - I started to feel pretty good. The procedure itself was painless. Hope that helps. Good luck. Mark
My AF experience was much like yours and I did put it off one time. I finally did it and have been so happy I did. It’s been a year with no events and all is well. My healing was pretty uneventful but I did slow down for a while to give the heart time to rest as it healed. During that time I did my mostly normal daily routine but avoided anything strenuous. I found the procedure to be fine and the only hard part was being still for several hours afterwards. I’m not especially good at being still. Other than that it was easy enough. I would absolutely do it again. Being able to get off some meds is worth it, as well as no longer having episodes. I do have a loop recorder so I don’t worry about missing an episode of AF as my doctor gets a report daily and he will advise me if anything changes. All in all having the ablation was a great decision for me. Best of luck with yours.
Hi RoyMac,My AF also started in my early 60s with occasional PAF episodes, usually overnight. After about a year I was scheduled for an Ablation. However it didn't happen then because I was anaemic from other medical problems.
Over the last 10 years my AF has progressed and is now persistent and is seriously affecting my QOL. After a long wait due to Covid, my Ablation is scheduled for next Monday and I can't wait to get it done !
Of course, we are all different but I wish I had been able to have my ablation much sooner, when I was younger and fitter. Good luck with your decision.
By asking the question should I or shouldn't I, you have answered it yourself....postpone for 6 months, procedures will always improve during any delay. You need to see if you can stop the episodes with your current regime plus moderate training and introduce other better lifestyle choices. If no success, then at least you will know you tried and can go into an ablation with more conviction.
I am 66 and had ablation here in UK last August. At present it looks like a brilliant success. My AF was almost certainly exercise induced and I first got it 3 years ago mid triathlon (mid Russia!). It was paroxysmal with increasing frequency and brought on each time with less exercise intensity, latterly without exercise. I had eased right off exercise intensity. After ablation I felt rough for a month and had many ectopics (early/delayed heart beats) especially after walks, detected by my Kardia Mobil 6L ecg device (£150). By 3 months I was cycling up to 40 miles but still sometimes getting ectopics. After 6 months things got much much better, ectopics became a rarity. After 7 months I had my cardiologist follow up and he said he ‘has no restrictions to place on my exercise regime’ apart from limiting running to 40 miles a week (double what I had been doing at time of first AF), happy days. I’d plotted a graph of ectopics - see here. I have now entered two triathlons (90 minute ish events) and am hopeful whilst realising AF may return. I am now only on anti-coagulant meds and they’re optional. I will increase exercise intensity gradually. Nb my blood pressure is normal, weight is normal and I pretty much gave up alcohol 3 years ago on Drs advice (was on 25 units/week = 2.5 bottles of wine). I agree with the mongrel comment above. Good luck!
Thanks SR&PMy workouts right now consist primarily of stationary bike. Typical workout is 60-75 minutes with avg HR of 130BPM. Maximum is around 145-150. So pretty good workout and even my occasional PAC's seem to be fewer and far between when in better shape. Been working out consistently since last Oct. I've never induced Afib with a workout.
My history of a-fib started similarly to yours, but it did progress to the point where I didn't care how long recovery took, I wanted an ablation no matter what. Recovery after the first was very bumpy and took months due to a poorly done procedure; the second was much better and with quicker recovery. If you're asking time frame, my successful ablation took a couple weeks before I felt normal, but didn't proceed with my usual activities full force until after a month. I hope this helps.
RoyMac,Your explanation of your AF frequency and lifestyle pretty much mirror mine. I led a very active life when my PAF started around the age of 58. It didn't affect me much at the time and the episodes didn't significantly lower my overall quality of life. I dealt with the infrequent episodes and skipped on my cardiologists advice for an ablation early on. I felt like my PAF was controlled (I had Pill in the Pocket for the infrequent episodes) and the ablation was a risk I could hold off. A couple years ago (at age 63) I started a run of AF episodes that were a few weeks apart and within 6 months I was having a couple a week.
I had an ablation (Radio Frequency PVI with a right atria flutter line) a little over a year ago. It took a week or so to recover from the surgery--to be up and around comfortably. And it took a couple months to be confident getting the heart pumping harder (exercise). There is always the three month or 90-day blanking period to get through and some will say that is the first test healing period. For me it was about 6-8 months before things felt closer to pre-procedure and all the new electric pathways were settled in. I've had no AF since ablation day, so I'm glad with my decision to get the ablation. Looking back, and given another chance I would have done it earlier. That last 6 months before the ablation were tough. Good luck to you whatever you decide.
Re af begets af, over 10 years down the line and currently my episodes have lessened over time. Asymptomatic so no ablation for me at the moment, the time I'm in af in no way amount to the time people seem to take to recover.
Thanks everyone. From reading your posts, it seem everyone's experience with AFib and ablation is somewhat unique. Hopefully postponing the procedure will work out with no more episodes prior to having it done. I really appreciate you sharing your opinions an experiences. If anything changes, I'll let you know.
Well I was told to have an ablation after having Afib 3 times. It turned out that my ribs/spine was out of line and pressing on the vagus nerve causing palp/Afib. Glad I did not have the ablation! I now go to chiropractor 3 times a month to be sure to keep my ribs/spine aligned. No more heart issues! I am 67, healthy, active and got palps/Afib with certain movement usually - bending over, stretching, lying on my left side.
I can only speak from a personal perspective but I am also 67 and have had PAF for a few years with my worst event taking about 60 hours to get back to NSR. I had my ablation in March and the recovery has been excellent.
I take regular exercise but not the extent that you do and in terms of the recovery I would read the advice sheet and then judge your own pace but don't push to get back to your previous regime. I just went out for walks and increased the length and pace steadily over a couple of weeks with no adverse effect.
I had 3 ablations. Not only did they not help they caused rare complication. Ablation is a heart procedure that should not be taken lightly. It is often talked about as no big deal but it is. I would recommend not doing it unless you cannot live with the afib.
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