Do I need an Ablation ?

[Rhythmking]

I had a recent cardioversion which put me back into sinus rhythm for just one week. During this week I hadn't notice any significant difference in how I felt, with the exception of feeling quite lively for about half a day ( I assumed this was maybe something to do with the anaesthetic)

In a recent follow up I was informed by the Cardiology Dr that most people notice quite a dramatic improvement/change when reverting to sinus rhythm.

My symtoms have never been too bad I dont think, but I do have periods of extreme tiredness which last for a few hours most days, maybe caused by the meds now ? I'm not sure. Taking Bisoprolol 2.5 mg & rivaroxaban 20mg once a day. Plus Flecainide 100mg twice a day. Also not prescribed for AF but on Atorvastatin 20mg one daily, started about same time as Bisoprolol. My AF is persistent & was first noted about 9 -10 month ago.

I have now been offered & am currently on the waiting list for an Ablation.

I'm wondering if this will this be of real significant benefit to me as my week of reinstated sinus rhythm, following the cardioversion, didn't actually cause me feel much different . I'm assuming if successful I could lose some of the medication & presumably it would be better to be in sinus rhythm rather than not irrespective of how I'm feeling.

Any advice gratefully received. Many thanks

[Hidden]

Good afternoon Rhythmking, our 'Treatment Options for AF' booklet might be interesting for you to read, along with the decision aid 'Making a decision about further treatment for atrial fibrillation', in helping you to make an informed decision. You can find them here: heartrhythmalliance.org/afa... If you would like to talk things through with our Patient Services Team or would like any other guidance or support, please feel free to contact them on 01789 867 502 or email [e-mail]

[Rhythmking in reply to Hidden]

That's helpful Katrina. Thank you

[Paulbounce]

Hi Rhythking.

Here's my take. My last cardioversion lasted two years alongside taking Flecainide. That's a good run for a cardioversion. The fact that your heart was able to return to sinus (even for a short period) means an ablation may work for you. However some people need 'tops up's and the first may not work and you need another. We are all different and in some ways it's luck of the draw.

I have been offered an ablation but decided to try another CV first - if I can pull another two years out of the hat I'll be very happy. However if I only had a week in sinus then abalation will be the next step. I feel that ulimatately this is a decision only you and your EP can make. I'm going to link to a video below by Doctor Gupta - one thing to note is it was made in 2016 and technic's for the procedure have improved since then.

Paul

youtube.com/watch?v=3VOq9BL...(Not working as expected?)

[Rhythmking in reply to Paulbounce]

Thanks Paul. Interesting video . All food for thought. A lot to think about.

[Paulbounce]

Sure Rhythmking - it is food for thought. I only put the video on as you wrote "I'm wondering if this will this be of real significant benefit to me as my week of reinstated sinus rhythm, following the cardioversion, didn't actually cause me feel much different". It's something to discuss with your EP but if your medic thinks ablation is the way forward for you then (personally speaking) I would heed the advice.

Good luck whatever you decide.

Paul

[Budken in reply to Paulbounce]

It all depends on who the Doctor is. Does he perform many ablations? I went to one Doctor who said I should get an ablation, that was ten years ago. My regular Cardiologist said, " that Doctor makes lots of money, performing Ablations. That is all he does! " That was definitely food for thought. I did not see that other Doctor again. I take Flecainide 100mg twice daily, and it has kept me in Sinus Rhythm all this time. I have not had one single outbreak in over six years. On November I am getting a Holter Monitor to check for sure. My current Doctor here in Germany, wants to reduce the dosage. I am a bit worried about that. Originally I also took 25mg Metroprol daily, but my last Cardiologist thought that was the reason I was having occasional outbreaks. When I stopped the Metoprolol six years ago, those outbreaks stopped. It is even rare now to have PVC's which I had always had from time to time. I credit it all to the Flec. I will say weaning off the Metoprolol was a real roller coaster ride. I thought I would die for sure! Which is why I worry about reducing my Flecainide.

[Paulbounce in reply to Budken]

Hello Bunken.

I was also on flec for around 2.5 years. My cardio just took me off it (bad call I think) and put me on Sotalol. No withdrawal problems at all. For many it works wonders and really can help with afib.

Paul

[secondtry]

I am also on 200mgs Flecainide and no energy loss, suspect it is the Biso causing the issue but have no experience with that drug. If AF is still breaking through maybe an ablation is the answer but coming off the drugs afterwards needs to be discussed carefully with you medics before to avoid any dissappointment.

[Rhythmking in reply to secondtry]

Thanks for your reply.

[wilsond]

I had a similar dilemma. My EP suggested ablation and then several things happened.He put me on a daily dose of flecainide.and bisoprolol. This stabilised me so well,it was decided to continue but keep me on list.

Long wait here 12 to 18 months, plus the joys of Covid lockdowns.

Meanwhile,I had the best phone appointment with a cardiologist( I am also under another hospital for heart valve defect)

We discussed options and he said that at my age ,only 62,and with my family history( mother and nanna both had AF and.died of AF stroke,dad had triple bypass and valve replacement and grandad died 61 of heart attack after a stroke...) if it was him he would be demanding an ablation!

He said,even if I wasn't troubled by symptoms of AF and may not feel too different the heart would start to remodel itself sooner or later and then I would have both my arrthymias (af and flutter) getting the upperhand. Further complications would follow, left atrium enlargement etc. Then you face older age and all its travails with health baggage that could have been avoided

In his opinion it was better to ablate ,even if patient did not feel they would notice particular benefit.

I had thought ablation was only for QOL so had felt , like you,that there might be little point in it for me.

The end of the tale so far is that while waiting,I did indeed start to get awful extended breakthroughs,horrible.

If your EP has put you forward they have good reason to. Not insigificant cost so not done if not ' justified'

Hope this helps you ,the more info we have the better!

ps ablation for af and afl done June 1st, nsr since except once after dehydrayted.

best wishes

[Rhythmking]

Thanks for this wilsond. Appreciated. All very interesting. I've been put on the list but told I can change my mind if I want to. Feel its an almost impossible decision to make.