I now have the date for my ablation 24th March. I now have to decide whether to go ahead with it or not. Since late October and since a medication change (bisoprolol reduced from 2.5mg to 1.25mg and a maintenance dose of flecainide 50mg twice per day instead of 100mg PIP) I haven't had an episode of AF. Prior to the medication change, I had an extremely rough couple of weeks where I was going in AF quite frequently, sometimes twice a day. I was particularly bad immediately after my COVID booster jab, which could of course have been a coincidence. I'm fully boosted and in no way anti vax, I'm just stating a sequence of events. Anyway, that aside I'm hoping to speak to the arrythmia nurse today for guidance, but my gut feeling is to stay as I am. I was told the waiting list is now 12 months (I've been waiting 9) so I guess that's also a consideration.
Ablation Date: I now have the date for... - Atrial Fibrillati...
Ablation Date
Such a difficult decision to make and I know it has been a great dilemma for you. The only thing I would say is that it is commonly known that the sooner you have an ablation, the more successful it is likely to be. Regardless of the dose, Flecainide is a potent drug and at 61, you could be taking it for at least another 20 yrs and who can say how effective it will remain over that time frame. As I have mentioned many times, apart from problems during the blanking period, you rarely hear anyone on this forum saying that they regret having their ablation. I believe around 9000 are carried out in the UK alone and whilst there will always be risks, within the medical profession they are seen as low.
Only you can decide, I wish you luck………
It is a difficult choice and only one you can make as you are going into the unkown without any certainty. My own choice when faced with the same question was to go for it - simply because I did not want to remain on toxic drugs for the rest of my life. I had a bit of a bumpy ride and needed 2 ablations and have no regrets.
I think the fact that Flecainide has stopped the episodes is a very positive indication that ablation may help you.
Talk to your arrythmia nurse, voice your concerns and then try a little thought experiment
- how would you feel if you refused ablation and AF continued to progress despite the meds?
- how would you feel if you had the ablation and it worked well for you?
- how would you feel if you had the ablation and it didn’t work and had to continue on Flecainide?
I found that sort of thought experiment helped me decide what was right for me.
Thanks both, very useful advice. I feel my judgement has been clouded by the dramatic improvement since October. If I was in the same situation now as I was in Oct I'd be stripped and ready.🤣
It's sods law that you have been free from AF since October. I bet if you don't have the ablation on 24th March, a few days later you'll possibly have an AF attack.
I had the same decision about my gallbladder. I suffered terribly with pain just about every other night, then it just stopped. I asked my consultant what I should do and he said quite often this happens, but it would be far safer to remove it now than in 10 years time when I'm older. He also said I'd then say I wish I'd had it removed years ago.
I think a lot of AF forum members find that when they actually get an appointment date, they immediately wonder about whether it's the right thing to do. I've had three ablations and I know that's what I did.
There are many ways of looking at this, have the ablation now or wait and see what new procedures for AF are up ahead. Also do you want to be on medication for the rest of your life?
Jean
Why waste a chance to be off some very nasty drugs which may not always work? OK there is a school of thought that says the longer you wait the better may possibly be the procedures but my best intelligence is that there is unlikely to be a major sea change in success any time soon .
Think how you would feel if you did cancel and your AF became worse again and instead of waiting a month you now have eighteen months or two years to wait as you can be pretty sure that if you cancel this oportunity you will not be any where near the top of anybody's list.
Nerves are normal but logic normally trumps nerves.
If you care to look at my previous postings,you will see I had a similar dilemma over several years( helped a lot by lockdown!)I was feeling I would be able to manage longterm on flecainide and biso,as generally AF and flutter was being kept at bay. I put the ablation offer on hold twice,after talking with my EP.
I had made lifestyle and dietary changed,tried meds as PIP ,then as daily dose.
Quite suddenly,without warning or any obvious cause,I had two 5 and 6 week seperate episodes of 24 hour AF / or flutter within 4 months. I was on my knees and begged for ablation asap! Luckily,as I had remained on the list and was so affected I didnt wait more than a couple of months.
I ,however,was still whittering en route to hospital!
All I can add is that I had ablation for both 5th June 2022. NSR immediately and since except for one episode caused by GP telling me to cease flec.
Not even in the blanking period,which I fully expected.
My EP prefers patients to remain on maintainance dose for up to 6 months he ( Proff Osman) says latest thinking is that the heart needs to be thoroughly retrained to stay in nsr.
I have every hope to stay as such and feel so much better.
I have congential heart valve disease which slows me down but other than that its happy heart days!
Its so hard to balance everything up,as its elective proceedure. If we had a heart attack we wouldnt be humming and haaing!
Of course every patient has their own experiences and outcomes but I hope mine is useful info.
Best wishes
Thanks everyone, I think I'll have the ablation. I have been here before i.e several months without AF, but it's always returned. That was pre flecainide, but it's obvious the condition is there without the medication.
Yes ,and I ended up on max flecanide,with no where to go and then it nobbled me good n proper!Yes its held at bay but as you say ...lurking in the background lol!
Hello Private Ryan. Our situations are very similar in many respects.
I’m a 62 year old male, and I had five AF episodes between 23 July 2022 and 17 November 2022, though I think milder than yours: in each case they came round about midnight, weren’t particularly awful, and I was back in NSR 40 to 120 minutes later. I went to A&E twice, but they were long gone by the time I got there. Diagnosis only confirmed by fitbit / kardia, plus portable device from hospital for a month. Since the last one on 17 November I’ve been on the same medications as you, Bisoprolol 1.25 (like you, reduced from an initial 2.5) and Flecainide 50mg twice a day. I also made lifestyle changes (no alcohol, no caffeine, no food within four hours of bed). And like you I’ve been clear since then, 104 days now. Not that I’m counting. Much.
I finally saw a very nice Electrophysiologist at Norfolk & Norwich Hospital last month. He confirmed that ablations are better done early etc etc but after a good discussion we felt that my AF burden is so low – a total of five episodes, probably out of NSR for not much over five hours in total, and nothing since mid November – that an ablation felt premature. I suspect an ablation lies in my future, and I don’t want to leave it too long, but even with that mindset there’s still a question of whether heart surgery is proportionate when my load is that low and QoL on the whole is good. For now I feel reasonably comfortable with the position, but I’m seeing the EP again in six months and I shan’t be surprised if the position changes at some point.
I guess you’re weighing up whether the ablation is proportionate in a similar way? And then there’s the question of the long term effect of the drugs which have been raised in reply to you, on which I have little information.
There’s no right answer is there?
Yes exactly the same situation as yourself. I have to decide by the end of the week and the chances of me speaking to the cardiologist are slim to zero. I'll see what the nurse says, but at the moment I'm favouring the ablation, mainly due to my relative youth, and of course the advice given so far.
Hi,
I was offered an ablation not long after starting with PAF about 10 years ago, I was then in early 60s and actually had the pre-op. Due to other on-going health issues, it didn't happen then.
My AF progressed, as it often does, and by Spring of last year I was in persistent AF and begging to get the Ablation for which I had been waiting for 9 months!
Of course, we are all different however my advice would be to get it done when you are as young and fit as possible. It definitely gets harder to recover from any medical procedure as you get older.
Good Luck
I would second this. I seemed to be improving last summer - episodes went down from week-long, with a few weeks free, to much shorter episodes. Went on the waiting list but wondered if it was a sledgehammer to crack a nut.
Then in October it turned persistent - quite suddenly. Had an ablation in December but went back into persistent A Fib very quickly. Waiting to see what’s next, but I do suspect that earlier treatment might have been more effective. Though I was only diagnosed last year, so not an option for me.
It is a dilemma when folk aren’t feeling too bad!
Hi I had cardioversion in December and it worked but I soon lapsed back. Talking it through with my cardiologist he said a couple of recent studies showed the case for cardioversion version wasn’t clear and just keep taking the meds and living a healthy lifestyle (I am doing ok on the former!)
I had a 6 sec pause after booster.dont think a coincidence...
The arrythmia nurse persuaded me to go ahead with the ablation, so I'll let everyone know how it goes. Thanks everyone again.
been following this thread closely cos I'm hoping I may be offered an ablation in the future, and could see your predicament. I'm feeling glad in my heart you've taken the advice of arrhythmia nurse! Good luck 😊
I had a pacemaker implanted after my first ablation in 2019. EP determined I also had sick sinus syndrome (which causes the heart to beat too slowly so Afib was likely keeping me alive). Also, not all of the Afib was ablated the first time.
Anyway, I was really leery of having a 2nd ablation (had a MI the day after and kidney failure) but had a different booster (Moderna - newer vax) last September. In reviewing my PM output the other day with my device doc, my Afib burden had dramatically increased mid-Sept until my 2nd ablation mid-Feb. It does make me wonder if the booster set off my AFib...
In any case, there is some research that indicates that getting an ablation sooner rather than waiting until if becomes persistent/permanent increases the likelihood of a better outcome over time.
The other thing is that your ablation may not fix all of your Afib and you may need a 2nd - but if the progression of your disease is not that far along, perhaps not. Afib is a tricky bit of business!
Finally, I am glad you've decided to move forward. I know it's extremely scary but I have to say that if your QoL gets better and you can reduce meds, mores the better!
good to read this as I’m going to be in the same position too within the next 3 months as I too have not had any AF episodes for quite a while ! I’m on Sotalol since they changed my meds and it appears to keep it under control . The consultant said it is easier to do it now otherwise in the future I could suffer from further heart damage. From reading these responses to you, I think I will go ahead with it.
Are you worried about the ablation itself ? Don't be . Procedurally I would rather have one than a large filling.I am 1 week post ablation and no idea if it will be successful over all but worth a try.2 years of persistent AF and difficult to make the decision.But take the chance of eventually being drug free.
Good luck whatever you decide.
Kathy
No not worried at all about the procedure, I once had a broken leg reset without anaesthetic, now that's pain. 🤣
Op and pre Op dates are now confirmed. The only question is how long recovery will take after the Op? I appreciate everyone is different, but I have a business trip to Italy planned in late April/early May, so I'm unsure if this would be wise? These trips aren't the relaxing experience everyone imagines, in fact we did more driving than flying on the last one, so I'll just play it by ear.
Hi PrivateRyan, I know that many here favour ablation; but I am finding that flecainide and metoprolol works so well for me that I am staying w/ the meds for now, because I do not have side effects and my quality of life is very good. One caveat to remember is ablation is not perfected, and all of my friends who have had 1 ablation have had to have 1, 2, or even 3 more, which is also the case with many people on this site. I did not like it when my consultant EP had NO knowledge of anything except "have an ablation"... as if, "to this hammer, everything looks like a nail" :-). I am in the medical field and am still interested in lifestyle changes, supplements, and careful use of meds. But, as everyone here would say, we're all so unique, and it's all about quality of life, and how you feel about yours. Wishing you a long life in NSR! Diane S.
I'm glad I booked the ablation now, as I went into AF at 3am this morning, the first episode for months. It only lasted a couple of hours and my heart rate kept below 100, so I feel ok this morning. As usual, I'm trying to figure out the trigger, possibly stress as I got wound up at work yesterday.😤
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