Hey guys, I am 42 and have paroxysmal vagal afib that only happens when I'm sleeping. I am on Flecanide and had zero episodes since.
I am now wondering what to do next, whether to do an ablation or not. I read a lot that ablation is better to be done sooner than later. On the other hand I read that vagal afib rarely progresses to permanent. Anybody who can weigh in and share their experience would be very much appreciated.
First episode of afib about your age. Cardioverted and took I believe digoxin for a couple of weeks. Then no meds. Next episode ten years later. Next episode ten years later. Then it started progressing. 35 years after first episode considering an ablation. Looking back probably should have had it four years ago but who's looking back 
Don't know what to advise without knowing the frequency and length of your episodes both on and off flecainide. But as to ablation, newer technologies just now becoming available like pulse field ablation (PFA), so I would be in no rush for ablation now if your afib burden is low and given your young age.
Jim
I would be inclined to agree with mjames1 post. Hold fire for a while.
My opinion is that ablation is a big deal and should not be entered into lightly although I know that my opinion is likely to be in the minority !
My first episode was December of last year and I've only had 3 (fingers crossed). I take Flecainide daily and Eliqius. I decided to have an ablation to prevent AFIB from progressing. The general advice is that doing earlier rather than later in the disease is better. But I'm older than you and they found marked left atrium dilation in my heart from "silent afib." I want to prevent any other issues with my heart, if I can.
I faffed about for 3 years with various drugs , and suffered with the various side effects, the hassle of taking drugs on holiday or work trips , and a dozen high rate ( 165 resting) AFIB attacks and four or five hospital visits that became overnighters or longer trying to get out of AFib, before finally deciding to have an ablation.No AFib now for over 5 years, and no drugs for only 3 months less than that.
If I had a time machine I would have had an ablation after my first AFib episode and missed out all the rest!
Having an ablation does not guarantee you come off the drugs. At 60 I turned down the offer of an ablation and at 70 I have no regrets. Its about quality of life, if its good the scales tend to tip towards don't change anything. Also I have learned you can't be complacent, continue to keep an open mind and double down on lifestyle changes - you are lucky you have been prompted to make beneficial changes earlier than I was!!
Let a cardiologist decide for you is the way I would always go since your heart will have its own peculiarities.
Steve
I also have vagal Af.
When it progressed to daily eposoides at night I decided to hold off taking Flecianide daily, I could use valsalva manuveours to stop them and if I had any during sleep they would self resolve. When I had AF where I could not stop it I would take 100mg of Flecianide.
I did this for over 3 months, at the same time I used a ECG monitor to record ever event.
Most nights on average 800 PAC's, 400 PVC's and 20 odd low burden AF events.
Now I am taking 50mg of Flecianide morning and night with 60mg of Diltiazem, I have not had any AF, PAC's or PVC's.
My question to myself is if I stop taking the meds every 4 months for one week to record events will my AF burden have progressed?
If you follow me here on the forum I will post results each time I experiment with my AF.
Robert
Hey OzRob, seems like you have a very similar case to mine, I just looked at your other posts as well. Are you considering ablation at all? For me I strongly believe there is a connection to my nutrition - contrary to what I read elsewhere for me hunger and lack of certain food types seem to be a trigger, at least for my PACs which have significantly decreased since I eat more meat (before I found this out I was eating less and less meat)
Hello, Andreas, I am with OzRob and others here who are trying to "stall" an ablation as long as possible. We are all biochemically so unique, and it all depends on what we feel is good quality of life & what we are OK with tolerating. In 14-15 years of paroxysmal, vagally-mediated afib, I have not had any remodeling of my heart (per my EP), and I learned that I can reduce my episodes greatly by eating less and earlier, staying calm in stressful situations, walking, listening to quiet therapeutic harp music, laughing more, and using breathing techniques.
Almost every single person I know (or know of) who had an ablation has had to have 1, 2 or even 3 more; I cannot believe that scarring the heart this much will be without repercussions in future, so I am hopeful that newer methods will be devised. But I have been one of those who has never had side effects from daily metoprolol (50 mg) or pill-in-pocket flecainide (150 mg stops my episodes). So staying on meds is not burdensome for me in the last 15 yrs.
BTW, you are correct--vagal AF can wax and wane, and does not always progress. My episodes are far fewer than in past. In your case, I would watch and wait. There are many medications you would also have the option to try, if episodes increased. Meanwhile, let's watch for advancements in ablation technology. All my best wishes for your good heart health! Diane S.
Dear Diane, this has been very valuable insights, especially the waxe and wane part - mine seems to be like that as well. Cheers and I wish you all the best and good health!
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