recurring problem to ablate or not - Atrial Fibrillati...

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recurring problem to ablate or not

foxglove1 profile image
29 Replies

a couple of months ago i wrote asking for advice should itake up offer of ablation if it was made near to my travel to australia. for christmas. had lots of really helpful replies Bob, Buffafly and lotsmore. I felt reassured about the whole ablation thing (previous very undecided) gave myself a cut off date and was offered late November which was too near my travel . the hospital were understanding and i’ve been offered end of Jan. So far so good.

Australia was a lovely happy time however on the way home think i was dehydrated as AF kicked in, in transit, and long story short I ended up in hospital in Singapore for three days. I was looked after very well no insurance probs and a great cardiologist. my dilemma now is he was not particularly pro ablation, said as my burden was low, every 6-8 weeks lasting 6 hours or so and why would i go through that when i could pop a low dose bisop morning and night. i’ve never taken bisoprolol as have lowish heart rate but now i’m back thinking should I have the ablation at all if I may come out worse off. i’ve read lots of you who haven’t been happy, but lots that have. if you’re still awake any helpful advice would be gratefully received. x

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29 Replies

Always a difficult question to answer. Many cardiologists, as opposed to EP’s, are not pro ablation, indeed the one I saw always gave that impression but my turning point was when he said, “if I were you, I would have a Cryoablation”.

Generally, here in the UK you are not offered an ablation on the NHS unless they are fairly confident that you will benefit from the procedure. It is commonly accepted that AF gets worse over time and that an ablation is generally more successful the sooner it is carried out after diagnosis.

Thousands are performed in the UK each year and the number of those who express concerns AFTER the blanking period on this forum is really small as the majority are just getting on and enjoying life. Even those who have had recurring problems often say their symptoms are less intrusive after having an ablation.

Of course there are risks, but within the realms of general medical treatments they are considered to be quite small. Provided you have done everything possibly to improve lifestyle then for many, ablation is a good route to follow. On the other hand, there are thousands of people who accept permanent AF, keep their rates controlled with medication and go on to lead near normal lives and wonder what all the fuss is about.

This is why it is such a difficult decision and I wish you luck because it’s only you who can make it. Personally, I have had two ablations, and no regrets……..

foxglove1 profile image
foxglove1 in reply to

thanks Flapjack. that’s reassuring and i guess when it comes to it i’ll go ahead. i’ll still be a bag of nerves on the day!

Jetcat profile image
Jetcat in reply to

well said, and some very good points.

wilsond profile image
wilsond

HiI had exactly the same dilemma,if you want to read my former posts on this you can see similarities. I do sympathasise!

Its difficult,I found,to have the choice. For example,in other cardiac situations ( heart attack,valve disease etc) its cut and dried that intervention is needed.

I decided,with my EPs support,to wait and see how I went on although he suggested an early ablation( very strong family history,and I was only 53)

I did all the lifestyle changes ,and a oeriod of high stress came to an end.However AF became more frequent so went on meds as a PIP, worked well. Then,AF broke through too much and I went on daily dose.

I managed to keep mostly steady,although EP kept me on ablation list. Fast forward 2 years ( Covid and lockdowns)

Af and flutter definetly got the upper hand despite being on high doses of flecainide and biso.

I had 2 extended very symptomatic episodes ( 24/7 for 5 to 6 weeks) which finally convinced me.(95% or so,still whittered about what to do right till the night before!)

I knew AF/fl was progressive but thought I could manage to put it off a long time. In hindsight I wish I had taken up the original offer!

Luckily in the UK our surgeons are not profit driven,so we can be relatively confident that if we are offered a proceedure,it is thought to benefit us.

I swung back and forth on this matter,read far too much about pros and cons and wasted time.

I feel marvellous now,and didn't realise how decrepit I was becoming with the AF burden.

I now want to build up my fitness again which will help general health.

I wish you all the best in your decision.

foxglove1 profile image
foxglove1 in reply to wilsond

wilson thank you - you’ve been through it, and so young but very happy for you that you’re doing so well and positive. Im 74 and fit, no structural heart probs and enjoy life but this ghastly af has me reading constantly the pros and cons of ablation. the time is drawing near and like i said to flapjack i’ll go for it but in fear!! my main concern is i’ll come out worse than when i went in. keep being strong

wilsond profile image
wilsond in reply to foxglove1

Its very unsettling to say the least. For me ,it was the elective element that affected my worry. In other words ,was I choosing to make myself worse off!BTW I am not so young now...am now 63. Had ablation in June aged 62.

Now,as you say ,you are fit,heart is in good working order,and your AF burden has not been at a level to create too many pathways,so all in all,a good candidate for a positive result.

Try to think ahead to being AF free and the warmer months coming ,by which time you will be back up and running, I'm sure.

I will be thinking of you. When is it planned for?

Best wishes xx

foxglove1 profile image
foxglove1 in reply to wilsond

wilson thought i had replied to your 2nd post but seems to have disappeared. Oh to be 63 again! my date is the 24th under a GA. i’ll report back. thank you for support. this site really is so helpful.xx

Jetcat profile image
Jetcat in reply to foxglove1

good old G/A you can’t beat it.👍

Physalis profile image
Physalis

If your AF has landed you up in hospital for three days then I would think it's a no-brainer. Bisoprolol does no good at all in my opinion. It never stopped my AF.

Ppiman profile image
Ppiman in reply to Physalis

That's interesting and bad luck that bisoprolol didn't work. 5mg of it has twice stopped fast Af and AFl for me in hospital within an hour, much to my relief, preventing the need for a cardioversion. At the time, I saw it as something of a wonder drug.

Steve

Physalis profile image
Physalis in reply to Ppiman

Bisoprolol is a drug that brings the heart rate down a bit. The trouble with me was that it only reduced my AF rate a small amount and brought my normal hr down so I felt tired.

It could just be that the AF and AFl was going to stop anyway. However, we are all different and what helps one person doesn't necessarily help another.

Ppiman profile image
Ppiman in reply to Physalis

I doubt the coincidence given the circumstances, but, as you say, it is possible. The doctor and an excellent arrhythmia nurse who I saw both seemed to think it a most useful drug. I was told that if I needed larger doses that it might lead to bradycardia and the need for a pacemaker.

Steve

Physalis profile image
Physalis in reply to Ppiman

That sounds a bit extreme. And, I think, silly as there are other drugs which you could try.

Ppiman profile image
Ppiman in reply to Physalis

Sorry - I could have added more. As it was written it seems "extreme", perhaps. My apologies. But in my case (and in many cases) drugs that can lengthen the QT segment like sotalol or flecainide aren't safe and amiodarone isn't really useful for long term use.

Her point was that in many people, a beta blocker is the best treatment, but that when the dose needed for it to work is so high that it causes bradycardia, then a pacemaker is used to keep the heart rate up while the beta blocker does its work. That is, so far as I know, one of the major reasons why AF sufferers are given PMs,

Steve

mhoam profile image
mhoam

Hi,

I had PAF for about 10 years and was offered an ablation in 2014. Unfortunately it didn't happen then due to a different medical problem causing me to be anaemic.

My AF got increasingly worse and became persistent in April 22 after a bout of Covid. I had a cryo-ablation in June 22 and it has improved my QOL enormously. I still have PAF very occasionally but 100mg Flecainide resolves them. It is great being in NSR :-)

I was 72 when I had the ablation and wish I could have had it 10 years ago! Of course we are all different and there are no guarantees, but I would personally recommend you take the plunge and get it done.

As said elsewhere, this forum tends to hear from those people whose problems continue, not those who have had successful treatment and are getting on with their lives.

Good Luck!

foxglove1 profile image
foxglove1 in reply to mhoam

Hi Mohammed

thank you! the encouragement i’m getting is great. especially when i hear those saying they wished they’d had earlier. thing is it’s our hearts! i’ve had paf for years and prob should have dealt with it when i was younger but hey. youve been through it with Covid too and good to hear it’s all going well.

Gumbie_Cat profile image
Gumbie_Cat in reply to mhoam

It’s interesting that you mention the bout of Covid. I was diagnosed less than a year ago, though I think I must have had previous bouts of A Fib as they lasted several days at diagnosis - breaking through the dronedarone. Towards the end of last summer I had shorter bouts,. Tried the PIP of Flecainide with Bisoprolol in late September - but it took a couple of days to work.

Anyway, I had Covid at the very beginning of October. My heart was reasonably settled throughout - but the next bout of A Fib in mid October has never terminated. I had been told to go to A&E for a cardioversion if the PIP didn’t work within 6 hours. However, they just gave me more Flecainide to reduce the rate and sent me home. I really felt like a time waster, which makes me reluctant to even attend again.

Had an ablation in December, though I’m still in persistent A Fib so just need to see what’s next at the three month check. (Though my GP has told the EP, so might hear sooner,)

Have to say that the experience was absolutely fine, I’m just suspecting that I’m one of the people it hasn’t worked for, first time. Still the blanking period, but I’m concerned that it’s persistent.

I just keep wondering if that Covid infection speeded me onto the persistent route, even though I was fine while I had it.

mhoam profile image
mhoam in reply to Gumbie_Cat

Gumbie_Cat,

My AF has often become worse whenever I have had other medical problems. I do think the bout of Covid, which wasn’t too bad in itself, caused my AF to become persistent. However I don’t think Covid specifically caused it but that AF worsens when the body is stressed through infections or injuries, physical or mental.

Cheers

Gumbie_Cat profile image
Gumbie_Cat in reply to mhoam

That makes sense!

k9poppypoo profile image
k9poppypoo

I had Cayoablation on thursday last week i am still a little sore but would say go ahead and get it done ,iwas worried before but it was a lot beter than i though good luck.

foxglove1 profile image
foxglove1 in reply to k9poppypoo

thanks k9poppypoo

did you have a general - another of my worries!

k9poppypoo profile image
k9poppypoo in reply to foxglove1

No local did not have any pain at all .

bassets profile image
bassets

I had an ablation a year and a half ago. After I was first diagnosed with a bout of af which put me in hospital for some days. It then calmed down for a while although it was very symptomatic. Then my asthma became worse and I was diagnosed with a fungus infection in the lungs and had to take an antibiotic almost daily whic exacerbated the af until by the Christmas before the ablation I was begging to be put on the list.

However, since my ablation everything has calmed down. I tried to stop flecainide but had to restart it as I began to have gentle bouts of af at night. Now, taking smaller doses of dilitiazem, flecainide and losartan, the af has vanished and I can get on with life again. I am expecting the af to get worse eventually but, but I’m hoping that if I keep my moderate lifestyle and exercise I will be able to put this off for a good while. So my ablation worked for me and at the moment, life feels comparatively normal :)

Desanthony profile image
Desanthony in reply to bassets

Hi hope your asthma and fungus infection has cleared up. My wife had an aspergillus growth in her left lung and got a referral to the National Aspergillus Centre at Wythenshawe Hospital and now 5 years after being on medication with them the growth has disappeared. Had she not got this referral she would have had part of her lung removed. She is so much better than she has ever been. When she was told to come off her fungal medication last October she was worried her asthma would get bad as they had also changed her inhalers but things have been great. We are off there for a check up in early February. Another main worry was her not being kept on with her consultant at Wythenshawe but they will keep her on and keep checking up on her.

Good Luck and hope your heart continues to behave.

bassets profile image
bassets in reply to Desanthony

Hi again, thank you very much for your very kind reply. I hope your wife continues to feel really well. I have been signed off from the Northern Lung department in Wythenshaw and although I still have my inhalers, I don't have the same problems with asthma now. My consultant was Richard Barraclough who was very good and referred me to a great physio who helped a lot. Give your wife my best wishes x

DKBX profile image
DKBX

My simple question to my EP, “if I were your father (or closest friend, etc), what would you recommend I do?”

Desanthony profile image
Desanthony in reply to DKBX

Absolutely.

DawnTX profile image
DawnTX

I had to and it’s the only time I felt human

Desanthony profile image
Desanthony

This is difficult. I was in persistent low rate AF and bisoprolol and any other beta blockers or calcium channel blockers or rate control drugs made me feel worse than the Afib on it's own so eventually stopped taking them. Cardioversions worked and I had 3 which kept me in NSR for about 3 years out of 4. Was waiting for an ablation but Covid interrupted that - I should have had my ablation in the April after lockdown and then after covid had more tests and scans and it was found that my heart had remodelled itself and further cardioversions or ablations would not work well due to this - disappointed but I am fine with a resting heart rate of under 60. Still going to the gym 4 times a week and enjoying life. However I would rather have had the ablation even though I would still be taking the same medication - anticoagulants, as I did feel better in NSR. Got used to my regularly irregular heart beat now and can live with it.

Can't make your decision for you but I would have had the ablation if I could.

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