I was diagnosed with Paroxysmal AF in 2020. I may have had it for a few years before but it was not detected both times I wore a holter until the third time when I made sure it came on by staying up and drinking a lot of wine! Atrial Flutter was also detected. I do not take any medication for it or anything else. I am 52 years old, keep fit and am normal weight. I generally have episodes of AF every 10 - 20 days or so depending on how hectic my life is at the time. They nearly always come on at night and then disappear the next day as soon as I am actively walking for 20 minutes or so. I was once diagnosed with sleep apnoea many years ago so that may be a factor.
I have seen two EPs who have recommended ablation. I have been offered an appointment in less than a month but feel a little pressured and under-informed. When I read the comments from the very knowledgeable people on this list I do wonder if its the right thing to do. It seems mine may be Vagal AF, perhaps with something else triggered by lack of oxygen at night due to apnoea.
My EP has suggested that of all the options, the Ablation is the most likely to give a return to normal function and that drugs / lifestyle changes will only slightly suppress its development into full time AF. I wonder about the risk / reward equation of ablation in practice and how many people have them and then go on to lead normal lives? You do tend to read about less than ideal results and get a little apprehensive. I'd much rather not have any surgery but I am sure that everyone feels the same when confronted with it. Apparently I am a good candidate for ablation because my heart chambers are normal in size and I'm still relatively young to have AF.
If I had a successful ablation, would that negate the need for all the future lifestyle changes or would you stick to them anyway? I also wondered if I had really committed to a holistic approach whether that might be a cure or if the EP is right that is will only delay the inevitability of permanent AF?
I have a feeling there's not a right or wrong answer but I'm under pressure to decide whether to go ahead and really grateful for any insights out there.
Thank you! 🙏
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sosho
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I can’t advise on whether or not you should have an ablation as my first episode was 11 months ago and I’m still a few weeks away from my first appointment at the arrhythmia clinic because of AF, although I also have a high ectopic burden. So I’m yet to find out what my AF management options are
As for lifestyle, absolutely yes you should make healthy lifestyle habits part of your daily routine. No matter what the diagnosis, no matter what the treatment. You don’t need to do anything extreme. Changes can be made, one habit at a time. Remember that just because you develop one condition, it doesn’t exempt you from developing another. You still need to look after your future self. Nobody ever gets younger and the risks of most conditions almost always increase with age. If you need to make changes, the time to begin is now. Invest in your future self. You know it makes sense.
LIfe style in my view is the No 1 thing to address with AF. There is so much out there showing benefits. It should be a lifelong thing, not a fad.
Ablation must always be considered part of ongoing treatment for AF and may need to be repeated but I am a great fan myself having had three for AF before my AF was terminated in 2008.
I can’t give you advice on whether you should have an ablation or not, but it’s really what gives you a better quality of life at the end of the day, it is the unknown though and I can understand why you are unsure.
I too am CHADS 0, I’m normal weight and no structural heart issues. Mine is also vagal. I am not on anticoagulation but I do take a very low dose Bisoprolol (1.25 mg). I used to drink alcohol until I was diagnosed.
I had very infrequent AF for approx 15 years before it was diagnosed last year at A&E. I could never get it caught on any monitors and I just thought it was palpitations. Due to increased anxiety, I was getting them every 3 weeks last Summer. As soon as I was diagnosed, I was put on Bisoprolol ( wasn’t given any choices) and I’ve only had one episode this year. I have made a lot of lifestyle changes too which I think have also contributed though. I still worry about it and I still think that one day I would like (and may need) some form of ablation and I’m holding out for them to hopefully come up with something that’s guaranteed successful ( I can dream 😊) They won’t give me an ablation anytime soon, as I’ve been told I’m not bad enough.
I suppose what I’m saying is I had mine for many years, it got worse and then it has improved. You won’t know unless you try certain lifestyle changes, including giving up certain things you like (which could be triggers) or medication first, whether anything will change or not. They say Afib begets Afib, but with me, it hasn’t ( so far). You could get your sleep apnoea looked into too.
Or you could go for the ablation, trust your EP and take the chance it will all work out for you.
Thank you Teresa for sharing your experiences. I was told by both EPs that having the ablation at this stage of life is preferable. They did not have a lot of faith in lifestyle changes.
I would also agree that lifestyle changes aren’t a “treatment” for AFib and in my case didn’t prevent it. I didn’t have anything to change when AF first happened. I could write a laundry list of all the goody-goody things I do on a daily basis but it neither prevented nor reduced AF in my case. Even so, it still makes sense to develop healthy lifestyle habits because it supports our general health. If you’re having an ablation in the future, you’ll want to be well enough to go through the procedure and make a good recovery. It won’t be a one-and-done situation, you’ll always be vulnerable to AF compared to someone who has never had AF.
I can’t help wondering though, whether it’s worth a try, at least until you perhaps have an ablation? Are you trying to change any of your triggers? It sounds like you know alcohol is one, so have you tried stopping that to see if it helps?
Edit: I’ve just seen below, that you have….and other changes. I suppose apart from medication, then there’s not much more that you can try.
I have/had a very similar set of circumstances. For the majority, our body is telling us that better lifestyle choices need to be made urgently on all fronts including spiritually. The question is can you and are you willing to make a host of changes, very likely there will be many including 'hectic' times; the reward is better health all-round not just less AF. However, we all get entrenched in our old choices and lifes and most are tempted by the promise of a 'silver bullitt' (an ablation) and then ignore the hard work of lifestyle changes to our long term detriment.
I was determined at 60yo not to go onto pills with potential serious side effects but equally I did not like the 70% success rate of an ablation, what they actually do to the body and the fact you may still need pills or another ablation. So long story short the Fleacinide pills & lifestyle changes won..... with 8 yrs and counting virtually AF free years but of course I have only kicked the can down the road and a level of anxiety persists. When feeling low, I tell myself I have already banked 8 yrs of full productivity, ablation techniques are improving every day and some lucky guys on here have been fine for 30 yrs on the same drug....so that should see me until 'a move to the next parish' 😁.
Hope something above helps, good luck and be assured its a subjective personal choice and you can never be wrong as we don't have the option of seeing how the alternative would have worked out.
Hi Elli, yes, I've been largely gluten free, stopped drinking, taken Magnesium Taurate and I've always eaten fairly well. This did help but I'd have the odd attack in stressful conditions. What I've not done is sought a nutritionist or someone who really understands to give guidance.
Its fair to say that I fall from the horse every now and again and often get away with it but sometimes not.
That’s a good start then. Personally I would go heavy on the lifestyle changes for a good year and then see how you get on. I see one of your comments further down the list about an ablation being a better option for you due to time constraints and finances. I would personally implore you not to have an ablation on this reasoning alone. It’s a risky and permanent option that’s not always necessary, doesn’t always work and can make your life a lot worse. Even when it does work it’s very rare that it’s one and done. Many people need to go back multiple times which is amplifying the risk every time.
I’ve also seen some people suggesting slow and steady changes. I totally disagree. If I could go back I would go MEGA strict straight away. This is your heart we’re talking about and you only get one. It’s not worth the risk. A sensitive heart that doesn’t feel like it pumps efficiently is life changing trust me.
I’m not trying to put you off. Sometimes ablation can be a viable option. But with the benefit of hindsight I wish I’d been even more strict with lifestyle changes. My ablation has made my situation so much worse. It’s just not worth the risk until you run out of options in my opinion.
Yes, I think I need to try and work out how much this is contributing. My partner has not complained to me much recently so I assume I'm not snoring but perhaps just not breathing enough. Was there a way you found out it was this? Perhaps an oxygen monitor?
It wasn't so much about the snoring with me, it was the sudden gasping for air that woke me up and in turn my wife up, but in truth she said I had been doing it for years and we didn't think much of it. ( we had been married 40 years 4 years ago when I was diagnosed with severe sleep apnoea 58 episodes an hour and I am not overweight which is why it might have been missed ) . I actually posted on this forum about waking up 5 times a night thinking I wanted a pee but didn't really and when I checked by blood pressure it was very high. Someone asked if I had been checked for sleep apnoea so I duly went to the doctors and was given a verbal test and with a score of 21/24 was referred to the sleep clinic and within a month was on CPAP ( Controlled Positive Air Pressure ) and it changed my life!
I feel that having an ablation is a bit like playing Russian Roulette, some people win and are well and others like me find that they can make your symptoms worse. My first two certainly made my attacks worse and I'd often end up in a hospital ward. Once when in a ward after those two ablations the cardiologist there actually suggested that the scar tissue from the procedures may have made my heart a bit stiff in its working.
My third ablation did reduce my high pulse rate and immediately after having it I felt better, though I did have a few episodes of tachycardia which were resolved by cardioversions.
Where am I now with AF, well I'm in it constantly and life is a lot easier as the rate is usually between 70-100, but I have made quite drastic lifestyle changes.
How I wish someone had recommended lifestyle changes to me before I had any ablations, would I have listened - probably not, because I thought an ablation would be a quick cure. I was led to believe there was every chance it could be, but of course it wasn't.
What changes have I made to my diet, well I cook all my meals myself and I know what's in them. There are no nasty artificial additives and my meat consumption has dropped drastically. When I buy things to eat, or drink I look at the contents and know for a fact that artificial sweeteners were a sure trigger for my attacks. Alcohol, like wine usually has sulphites added to preserve it and for me and many other members here is to be avoided, though I can often get away with just one glass. Cutting down on sugar, caffeine, losing weight (if needed) and moderate exercise can all help.
There is someone called Steve who occasionally comes on to this forum that has completely cured his AF by diet. I'll go and see if I can find you the link to how he did it.
Dr. Randall K. Wolf out of Houston Methodist Hospital has pretty much proven the vagal nerves causing AFIB are on the outside of the heart. When the odds favor this for vagal AFIB, I just don't understand the logic in wanting to permanently kill heart cells on the inside of the heart. Catheter ablations have what - a 55% success rate? Granted, if you have androgenic AFIB, my discussion above may be mute. Mini-maze or nothing for me!
Yes, what you say does make sense. The figure I had quoted was 75% success rate. He is proposing to use 'the cryoballoon technology to achieve pulmonary vein isolation'. Not sure if that is the normal procedure?
Exterior pulmonary vein isolation is a good start. Clipping the left atrial appendage and checking the ganglionic plexi on the exterior of the heart would be even better for long-term success.
As others have said, this decision is yours and yours alone. For myself, with the frequency that you say you have I wouldn't hesitate. My ablation is now 20 months ago, and the last 7 months without any AF has been bliss. I didn't have instant success after the ablation though, so I must warn you that everyone's story is different.
I agree with BobD, lifestyle changes have to be the primary concern, but NO, they will not be a cure. Ablation is not a cure either, but part of the treatment that might keep you working normally for much longer, and I think is better than drugs.
If you think it may be sleep apnea why not try a sleep apnea cpap machine?
I am of the strong belief if your Afib burden is not great then try everything possible before entertaining the idea of an ablation.
Watching all the YouTube videos from York Cardiology will teach you more about Afib than any other source, you will learn all about how important Magnesium is for Afib, sleep apnea and Afib, what vagal Afib is etc etc
Thanks OzRob, I looked at that and was diverted to another product that had fairly good feedback and meant you didn't have to wear anything at night. Its the eXciteOSA. uk.exciteosa.com/
No idea if it would help so I'd need to look into this more
I reckon that it’s always a personal choice. I was diagnosed in February, but likely had it before then. At first I was getting monthly episodes, despite Dronedarone which made me feel very lethargic anyway.
Then I was told to stop that and try ‘Pill in the Pocket’ Flecainide and Bisoprolol. This hasn’t worked, and my latest episode has persisted for over three weeks. While it is at a lower rate, I just don’t feel like me at all. Very tired in the mornings, and walking uphill or upstairs makes me tired with aching legs. So I feel that it’s affecting my ability to exercise , which will only further exacerbate the whole thing,
As an ablation was offered at my first visit to Cardiology, I’m going for it. (A naturally low resting heart rate has also made rate control difficult when I’m in A Fib.)
There's some really top responses, I'm really impressed... I'll have some reading to do over the weekend. I just don't feel qualified to make the decision yet and there are obvious benefits in both approaches.
I guess for me personally I should probably be honest with myself and say that my life is not settled enough to be consistently eating the best foods and sleeping regularly. Its actually quite difficult to change that now for obvious financial reasons. That might mean ablation makes more sense.
It would be great to get back to more of a normal life. I used to be quite sporty but now I don't like to risk it. I've found raising my heart over 150 in exercise for too long can bring on a bout. I'm totally happy to eat really well and try not go crazy with work or 'unwinding' but it would be great if you didn't half expect the first thuds when life throws a curveball.
I'm also interested in the Mini-Maze. Perhaps that's a compromise? Has anyone had this procedure? Seems to be available in the UK
Look up mini maze on major health sites as it is a more invasive procedure than ablation, can certainly be beneficial but at this point in your afib journey it is unlikely that you would be a candidate for this procedure. That said, certainly discuss this option with your health care team.Recent reasearch does show that successful control of afib is more likely with early ablation, though for many legitimate reasons this is not always a suitable approach for everyone, nor a choice people are comfortable making without exploring other treatment options.
Very personal and challenging decision you have to make - I can certainly empathize.
Note though that ablation is not a panacea for everyone - I have had 3 ablations in last 23 months and afib still occurs on a paroxsymal basis (though my quality of life now with afib is greatly improved in comparison to 2 years ago).
You don’t need to do sport. A walk is still exercise. Think in terms of gradually introducing good habits and not big changes that are unsustainable. As for diet, you can do it on the cheap. It doesn’t have to be anything fancy or photogenic, and you can start by making one small change. If you take sugar, do without. If you like fizzy drinks, switch to water. Whole grains instead of white/refined grains. Add just one portion of veg. If you are fortunate enough to have a freezer, keep some frozen veg in stock. There is no such thing as a superfood. Cheaper fruit and veg is just as good, and so is frozen. Try getting to bed half an hour earlier and try not to eat or drink anything other than water after your evening meal. You don’t want your body digesting all the way through the night, so try not to eat for a few hours before bed. Screens and blue light are the enemies of sleep, so no phones or computer for at least an hour before bed. One small step, one tiny change every week. It will all add up. Go slowly. Big ambitious changes are rarely sustainable.
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