Older female, need thoughts on ablation decision

[37Polly]

ok, here goes…I have had diagnosed afib and Aflutter since 2017. Had a pacemaker installed Jan 2020. also have well controlled colitis. No other major issues. Never overweight, never smoked, drink wine modestly with dinner, however I am a small older woman. (82 this month🙏)I am active. Still play golf a couple times a week. Married, 591/2 yrs and counting. He’s 83, well and a gem, obviously.

Issue: should I have an ablation? Had a bad year with lots of debilitating afib every month until two months ago. When I go into afib I go high, (160-170) and cannot function. Two of my four covid shots put me into major afib and aflutter for over 10 days. Thus the decision to go on wait list for ablation.

Now I am wondering. Two months and no afib. And it’s been stressful time…moving into new house, we built. (Don’t all octogenarians build a house at this age?😜). Lots of delays because of supply issues. House guests and celebrations, heat and gardening, and I feel fine. Now I am being careful. Oh, and yes I am on beta blocker, major rhythm med ( Tikosyn) and Eliquis. EP surgeon is highly recommended. He say it’s my call. Cannot guarantee the afib cure but pretty sure about the aflutter and high heart rate. Am concerned about recovering. I am a very slow healer and at my age, hate giving up time.

I know there are some real experts in this crowd. Been here mostly listening for five years. If you have read this far, please give me your thoughts. I will be in your debt. Thanks.

[CDreamer]

Hi Polly - it’s SO personal. I can only say what I would do given the brief you have posted and using my own hindsight experience - in a word - no I wouldn’t go for it.

Reasons

- recovery time after ablation can take much longer than you are given to expect.

- just at the moment your say your AF is manageable now that you have recovered from the upset of the COVID jabs and you have managed during a stressful time. But that’s me and from hindsight and you don’t yet have foresight (if only!).

Ablation works for many people but not everyone so you need to ask yourself Would I be better off with or without? I meditate on this type of question when logically I can see both arguments for and against and feel stuck. I start by:-

Would I be better off with or without? Then start breaking it down thus:-

How would I feel if I had the ablation and all went really well and no more AF?

How would I feel if it didn’t help the AF or took longer than expected to recover ie: 3months+?

How would I feel if I didn’t have the ablation and AF got less manageable and more frequent?

Which outcome would feel better/worse?

Normally by now I have my answer and it’s all to do with how I would feel, no logic, studies or statistics involved.

Good luck.

[Singwell in reply to CDreamer]

YES this is great advice! My life coach pretty much put me through that process when deliberating about Ablation #2. So sensible.

[37Polly in reply to CDreamer]

Thank you for a really thoughtful evaluation process. I will share this with my husband and we will have a really honest look see. I am grateful for such helpful advice. P

[37Polly in reply to 37Polly]

Well said…thanks

[jeanjeannie50]

That's the big question Polly!

I've had 3 ablations and still have AF. As you have now gone 2 months with your AF behaving I'm wondering why that is.

After 17 years with AF I can tell you what I've discovered would trigger my attacks. Artificial additives in food, especially sweeteners. I eat a lot less red meat now and have fish about 3 times a week. Be aware of shallow breathing when absorbed in anything like watching t.v. and take a few deeper breaths right into your stomach (not chest) if you feel AF looming. Don't wear constrictive clothing.

I wish someone had told me all this before I had my first ablation.

The decision, or not whether to have an ablation has to be yours. In your shoes I wouldn't and I'd carry on as you are now enjoying playing golf and life in general.

How long do your episodes last for and do you feel drained for a few days afterwards?

Jean

[37Polly in reply to jeanjeannie50]

I, too wonder Jean. I have done a lot to work on myself and my life this past year plus. Not sure what is working but I won’t argue. I went back to daily meditation…did it years ago. Love it. Got serious about diet…no sugar, no starch, no processed foods. And only eat twice a day with night fast 16- 18 hrs. Feels great. Never hungry. Gave up vacation home and built a comfy “forever home” in a place we love near children and old friends. And devoted myself to my garden and golf. Low stress and truly retired. I am hoping it is the formula for the best of the rest.

Thanks for your time and thoughs. Hope I can reciprocate. P

[BobD Volunteer]

I am one of the greatest fans of ablation having had three for AF and one for atrial tachycardia but I would say no.

My reasons as follows.

Any and all treatment for AF is only for quality of life. Ablation does not remove stroke risk so anticoagulation will still be required. As CD points out recovery is no where like you wil be told by your doctors and can take a year in many cases.

Lastly and being a total cynic, the use of Tykosin suggest to me that you are in USA as this is not a drug licenced in UK or Europe and as such I worry that financial incentive may mean that doctors are overly keen to perform procedures which under our system they would not be so keen recommend.

Sorry to be blunt.

[Buffafly]

Maybe have the flutter ablation (not so long or invasive) and skip the AF one?

[CDreamer in reply to Buffafly]

That’s a thought - not nearly as invasive. I was told that AFL often led to AF so stop one, perhaps it would help the AF. I always felt worse with Flutter.

I always have to be the exception to any rule - my AF led to Flutter so when AF was controlled, no further Flutter.

[mjames1]

When you throw in the pacemaker, it's a little above my pay grade. Doesn't the pace maker control your rate both in afib and aflutter? If so, then what is the advantage of either an afib or aflutter ablation? Will they improve the quality of your life? If so, then it may be reasonable although doing an aflutter ablation alone, will oftentimes mean more afib, so think which is more troublesome -- the afib or the aflutter -- before you only do one.

Jim

[Buffafly in reply to mjames1]

Only if the AV node is ablated, otherwise it only stops the rate going too low.

[37Polly in reply to mjames1]

Buffafly has it right. The pacemaker only keeps the beta blocker from taking my heart rate dangerously low, which was the risk I had before the pacemaker, as I was severely tacky/ brady, meaning I normally had a very low heart rate until I had an episode. Then sky high..and the risk of beta blockers and the like was taking me too low and stopping my heart. No longer worry about that as it can’t go low…but still can go high. No one is suggesting we disable the AV node yet.

[Barb1]

An ablation is about improving quality of life. If you have that, why rock the boat?

[37Polly in reply to Barb1]

Barb, You are right where I am today. The past year, however was awful until two months ago when it all smoothed out. Makes me recall when we were younger and sailed. During every rough weather sail, I swore to NEVER sail again. Then I’d dream about the beautiful sails…and off we would go….Thanks for your thoughts. P

[wilsond]

As a young un of 62, I shall give my story . I dithered a lot ,it's very personal decision but eventually I decided to go for it as flutter was getting so much worse and interfering with my life a lot,as well as regular AFib.That was on 4th June and I've been in normal rythym since then. EP assured me that he was confident that the flutter has been at least 95% stopped.

I feel so much better than for years. I hope it lasts ,we shall see when I stop the medication! But if I need a touch up I shall agree to it.

You have a lot going on but I'd definitely consider it.

Best wishes xx

[37Polly in reply to wilsond]

Thank you. I appreciate your perspective. That’s certainly where I was last spring. Hard when I feel so well and am not having episodes. Must decide however before my number comes up.

[secondtry]

Ablation is always there when you don't have to ask should I or shouldn't I!!

[37Polly in reply to secondtry]

Good point. Thank you.

[37Polly]

Thanks, John. My daughters say the same. One has seen her husband, in his fifties and fairly fit, have a rough six months post ablation, though doing well now. She really does not want me to risk what I have at the moment.

I appreciate folks here sharing thoughts. This group has objectivity and real life experience, I value.

[Hylda2]

Today I saw EP and it’s pace and ablate for me