Is ablation warranted?

[Stressbaker]

I have had Afib since April 2020. I have had 2 episodes per year that each last 4-7 hours and have converted to normal sinus rhythm naturally. My electrophysiologist wants me to have an ablation. Is that really necessary at this stage of the game, with so few episodes? I am curious what other people’s doctors have recommended. I am trying to get a second opinion. Thank you so much for any insights shared!

[Hidden]

Hi,

I'm probably the worlds ultimate grumpy old cynic and therefore the last person to make an objective comment.

My answer is that he probably wants to improve his business revenue for this financial period. My non medical, non scientiific opinion is ....No!, I wouldn't go for an ablation at this stage ............. providing ------ there are no totally disabling signs that emerge during these bouts, or unless there is any signs detrimental to your health and wellbeing that impact seriously on your quality of life. I never sought my Doctors opinion .... I TOLD him that I would not consider an ablation ( back when I was diagnosed in January 2010). That said, if the events increased and became disabling on your life then it maybe wise to review things.

Since that date (2010) thanks to medication and diet my AF events ( about the same frequency as your which also resolved themselves) have continued to reduce and this year so far I've had none. I do not regret NOT having an ablation.

Did your Doctor/EP give any justification for wanting to undertake an ablation ? More importantly, did he give any probability of its success and that you would be "cured" ?

John

[BobD Volunteer in reply to Hidden]

Even though I am a great fan of ablation John I do agree on this occasion. Had it been UK probably not but we know how money talks.

[Stressbaker in reply to Hidden]

Last summer my EP said I would probably have 5 or 6 more episodes before the end of the year. I had one. He said the sooner you have an ablation after developing Afib the better your chances of success. He never said I would be cured. I just was not comfortable with what he was telling me. I appreciate your input!

[Peony4575]

I have only had two episodes 2and a half years apart each lasting 24 hours with a rate of 175bpm. My EP wanted to do an ablation now but I said wait for the third episode . Both episodes have had definite triggers and I want to see how far I can get with lifestyle.

[wilsond]

More likely to be financially motivated on the part of your EP.

[Jalia]

I would have thought not. As wilsond has indicated...possibly financial motivation. There are risks involved in any procedure so why put yourself through it with so few episodes.

[mjames1]

Short answer is "no". At this point, your afib burden is very low and likely can be managed without an ablation and without medications. Also, there's as new, quicker and safer ablation technology which will be available in the US in 1-2 years called Pulse Field Ablation (PFA). Another reason to wait, should your afib burden increase.

Just keep an eye on things because afib can sometimes progress quickly, but sometimes quite slowly. Part of the reason your ep wants to do an ablation is that in the US, ablation is often offered right away, as opposed to other parts of the world where it isn't. But that still doesn't mean you have to take it. I'm from the US and have been offered an ablation for the past 20 years, even though 20 years ago my afib burden was lower than yours. I'm finally getting one soon, only because my afib burden has significantly increased over the past year.

Jim

[Stressbaker in reply to mjames1]

Thank you so much for that fantastic info! Is that procedure available in other countries now?

[mjames1 in reply to Stressbaker]

Yes. Definitely UK, France, maybe other places.

Jim

[Nerja2012]

Stressbaker. I have had AF for 8 years and told at the beginning it would get more frequent with time, it hasn't, I average 1 every 10 months and always self convert. Only medication Apixaban. Ablation never offered .

[secondtry]

1. work hard on lifestyle choices, if episodes still increase 2. consults cardiologist on medication, if episodes still increasing 3. consult an EP to discuss the ablation option and whether any medication can be stopped afterwards.