Early ablation better at preventing AF progression than drug therapy

[Bagrat]

medscape.com/viewarticle/98... – Early ablation of atrial fibrillation (AFib) reduces the risk of progression, compared with antiarrhythmic therapies, according to results of a multicenter, randomized trial called PROGRESSIVE-AF."

[BobD Volunteer]

What I used to tell people. Get in quick before the atrium re-models. Gut feeling back then.

[Speed]

Thanks for sharing. Good to make such research results widely known. The better we are informed, the better we can make our own decisions in consultation with the professionals. I personally am managing PAF (latest episodes 3 mths apart) with medication with an option to go back to my EP in the future if it progresses. Maybe I should not wait?

[secondtry]

Thanks for posting. I have gone down the route of increasing the chances of an overall beneficial outcome by backing lifestyle choices to supplement drug therapy 🤞🙏😁.

[Bagrat in reply to secondtry]

Because my personal AF burden is very low in my opinion, I agree that lifestyle changes the first line of defenceor even attack!!

[LaceyLady]

I have Haemochromatosis in my family having Irish ancestry. My brother had it, most likely my other brother has it, sister is a carrier, so most probably I am but GP refuses to authorise a specific test. Both AFib and T2 diabetes can be symptoms and I have both 🤷🏼‍♀️ untreated Haemochromatosis is life threatening and I’ve family who died through symptoms that may well have been the conditions 🤷🏼‍♀️

[Bagrat in reply to LaceyLady]

That is tough for you. I have 3 friends with it, one who was much younger kept going for years then sadly died. The other 2 (78 and 93) are absolutely ok with treatment. Is there not a Haemachromatosis society who could fight your corner??

[LaceyLady in reply to Bagrat]

There is, there’s a campaign in Liverpool for obvious reasons, I’m a born Liverpudlian, family all come from there! My youngest brother as I’m sure you’ve seen posts had died through negligence in hospital, can’t say too much as I have an inquest.

Looking at the papers, he had autism, learning disability & schizophrenia. I’m seeing his heavy antipsychotic drug had a massive part to play in his demise but mainly no one seeing, treating that problem 🤷🏼‍♀️ He was let down by all he came into contact with medically.

I got brushed off from my Drs because they said the blood tests I had saidI haven’t got it! But I maybe a carrier AND one of the important blood tests my results were over the top but for some reason have lowered but not enough and yet I get no help!

[Bagrat in reply to LaceyLady]

Didn't want to like your post, but I have read it, all things medical seem to be a battle. x

[Ablation7 in reply to LaceyLady]

my friend has hemochromatosis. She has her blood tested regularly and what we call “the blood letting” as necessary. Sometimes her numbers are good enough that she doesn’t need it done. Hope you can get another test soon!

[Autumn_Leaves in reply to LaceyLady]

I know we discussed haemochromatosis on another thread but for the benefit of others reading this thread who share your concerns, the specific tests you need and that your GP can order are:

Total iron binding capacity (TIBC)

Transferrin saturation index (Tsat %)

Serum iron level

GPs are usually OK about ordering Serum Ferritin and if you have untreated haemochromatosis this will be high, but as I mentioned elsewhere, raised ferritin can be a sign of other pathologies and isn’t diagnostic for haemochromatois. If your ferritin is high then the next step would be the “iron studies” as listed above. If both your ferritin and Tsat % is high then the next step is to have genetic testing.

Whatever you do, don’t take iron supplements and check any other supplements eg multi vitamins for iron. Some fortified foods have added iron too. These can make your test results unreliable (but not the genetic test obviously).

And then, once you have your diagnosis the venesections begin …. Such fun! Not.

Remember, most people with AFib don’t have haemochromatosis, most people with T2D don’t have haemochromatosis, but someone with haemochromatosis will have an increased risk of cardiomyopathy, T2D and other problems, especially cirrhosis of the liver. So it’s important to be diagnosed and treated if you do.

Being diagnosed and treated didn’t stop me from developing AFib, nor did it reduce my ectopic burden. It’s important to be realistic but on the other hand you don’t want to make things worse.

If your GP won’t order the tests, ask your cardiologist. They should also be keen to rule of anything that could cause future complications.

[LaceyLady]

prevention is better than a cure but our health system isn’t wired that way.

[Bagrat in reply to LaceyLady]

So true.

[Ppiman]

I read this with interest. I felt that there must be so very many likely confounding factors given the relatively short period the study covered, such that the conclusion reached was probably questionable, but let's hope it proves to be so.

Steve

[Bagrat in reply to Ppiman]

Agreed, you may have seen me waxing lyrical about interpretation of studies, good bad indifferent or flawed but an amazing number of all "brands" get published!

[Ppiman in reply to Bagrat]

I used to work in the pharmaceutical industry and whilst I'm not cynical of it, I remain somewhat sceptical of studies on health conditions that are so varied, with circumstances, age, genetics and such like.

Steve

[LaceyLady in reply to Ppiman]

I remember doing probabilities tests and found you could get the answers you hoped for!

[Ppiman in reply to LaceyLady]

In my years in the industry, I met many doctors who were led astray by their misunderstanding of statistics. It's why we need those vital peer review journals - but even they struggle and their peer review panels have been shown wanting at times. Still, as a checks and balance, it's likely as good as we can get and perhaps, need.

Steve

[LaceyLady in reply to Ppiman]

I had a patient who saw how Drs were curried favour, if that sounds right without completely discrediting them.

[Ppiman in reply to LaceyLady]

Well, I always feel that no one is perfect but that knowing what "perfection" is, is something we need to make life all the better. Each person's idea of it varies though.

Accepting that no human enterprise can be perfect has helped me. I actually enjoy the thought that even the greatest can be led astray and that we are all different. It's brought about some fantastic computer stuff, too, with AI taking the subjectivity out of healthcare - but give me a real doctor any day, foibles and all.

I sometimes find myself smiling when I read people on forums complaining bitterly about "poor doctors", too. In some cases, a bit of self-examination and reflection might help them see that the issue isn't always with the medic.

Steve

[Autumn_Leaves in reply to Ppiman]

I am totally in favour of research into the causes and treatments of as many conditions that affect people. I am rather fed up with this anti science and “we’ve had enough experts attitude” that is so prevalent now. Do people actually want effective cancer treatments (for example) or have they “had enough of experts” when it’s their loved one who is diagnosed and desperately wants to survive? How do they think these treatments are going to come into existence if not for research and by definition will include much trial and error? Just talking on another thread on haemochromatosis, when my dad was still alive, there was no genetic testing or ultrasound or MRI scans and had no idea that they had the condition until they had end stage liver cancer or cirrhosis, and even then the diagnosis could only be confirmed post mortem. Fast forward a couple of decades and we have genetic screening, early diagnosis, venesection treatments and regular liver ultrasounds. Did we get here by saying “we’ve had enough of experts”?

I also agree that some people should examine their attitudes and expectations when they engage with medical care. There’s nothing wrong with being well-prepared and well-informed before going to see a specialist, there’s nothing wrong with asking questions about potential treatments and asking about risks v. benefits. We should see the relationship as a partnership, not seeing ourselves as passive and having things “done to us”. Most medical professionals are happy with patients who are active participants in their care. They mostly like well-motivated patients. That’s not to say that there aren’t problems, or that people aren’t happy with their treatment or their treatment is ineffective. That certainly happens. And if we rely on the NHS, appointments are scarce, time spent with a specialist is limited and in some areas of medicine, referral criteria is strict and/or the waiting lists are long. So there’s plenty of room for disillusionment.

[Bagrat in reply to Autumn_Leaves]

Yes, yes, patients and families/ informal carers are an integral part of the interdisciplinary team!

[Autumn_Leaves in reply to Bagrat]

Support matters, definitely. Good support from a spouse or family can make a difference but for some people their relatives run a mile and sadly partners can walk out. People living alone with a chronic condition can struggle not just with their illness but with isolation, money troubles and poor mental health.

[Bagrat in reply to Autumn_Leaves]

Agree many people don't have the luxury offamily or friends. People whether patient or carer need an advocate to help them navigate the system too, mind you the system is threadbare these days, but still obscure for the average recipient.

[Autumn_Leaves in reply to Bagrat]

Yes, my friend lives alone and her mental health isn’t good. She has no social support, doesn’t eat, has money problems. Fortunately she’s had a few appointments with a social prescriber recently and they put her in touch with people who can advise on managing money and a befriending type of service that’s attached to mental health services. Unfortunately when someone develops these depressive type problems they can become quite resistant to accepting help. I think she is suffering quite badly. I’ve tried to guide her towards getting help, but she will go to her appointments with quite a negative mindset and not want to engage with what’s offered to her — but I also think that’s part of the depression. She does have a chronic physical condition but the social isolation after medical retirement has hit her quite hard. Lack of support can be very damaging.

[Ppiman in reply to Autumn_Leaves]

Yes, I couldn’t have put it better. The NHS seems to be going through a really difficult time if those I know who work for it are representative. Too many left following Brexit and Covid and staff absence is bringing some to breaking point.

The immediate future looks to be shaky in so many areas of life. How local authorities can cut back further I just don’t know. Schools have come to rely on so many more auxiliary staff that their budgets are already squeezed. Social care is so short staffed, too… Goodness, it looks bleak .

Steve

[Autumn_Leaves in reply to Ppiman]

It certainly does and it’s no time to be getting old, is it? 😱