Obesity and ablation

[Biglad1]

Anyone had ablation who is on the large side. Maxed out on digoxin and bisoprolol apixaban & entresto and ef is 27% reading is suboptimal due at afib. Been in afib 5years now never tried cardioversion just left it as it was with meds. Fed up is an understatement only thing about leaving it is covid come along

[BobD Volunteer]

Here in UK I fear few EPs will offer ablation unless you have addressed life style issues if you are obese. The LEGACY trials in Australia a few years ago showed that a reduction of BMI to 26 or better often removed the need for ablation completely.

[mjames1]

Being on the "large side" significantly impacts how successful an ablation will be. Being in what sounds like persistent afib, also does. Together, the odds of a successful ablation are not stellar. You can't change the fact that you're in persistent, but you should consider losing the weight if you want a better chance with the ablation.

Alternatively, there is mini maze and the hybrid/convergent procedures which may give you a much better chance of success. They are minimally invasive surgery, but definitely more invasive than catheter ablation. Hopefully, if your ablation is successful, your ejection fraction will come back. PS They may want to try a cardioversion first, to get an idea how stuck your heart is (or isn't) in afib. If cardioversion is successful, that means ablation has a better chance of working.

Jim

[MummyLuv in reply to mjames1]

mini maze requires a bmi under 40, surgeons will ask you to try and get under 30. As it is done using thoroscopic instruments they have to reach the heart.

[DevonHubby1]

Wife has been in persistent AF since March. Was on Bisoprolol and despite dieting could not shed any weight. Cardiologist switched her to Nebivolol and it helped with her AF symptoms and now she's having some success with the diet. On other posts others have said Nebibolol did not help them shed weight so not a silver bullet buy might be a conversation starter with Cardiologist.

Wife is still in persistent AF. Consultant is waiting for all tests to come back but at moment he's inclined to suggest cardioversion as next step as when wife was in paroxymal AF she had a good QoL. He ghought her weight would not be an issue for the cardioversion .

[CDreamer]

Good advice above. I have to say that I put on weight with Bisoprolol, almost 10 pounds and although I’ve not taken it now for 10 years, as you age you will find it harder and harder to lose weight.

Until you address the root cause I don’t see how an ablation will help you, which is why you may struggle to find an EP who will offer you the procedure but weight is not the only factor, age, general level of fitness, co-morbidities etc will also count - but it does depend on what you mean as large.

[Jafib]

When first diagnosed with afib I was 90+ pounds lighter than I am today. The flecainide and metoprolol have definitely changed my heart rate, bmr, and, as a result, my qol. Now, they have trouble with my annual ultrasound to check my bicuspid valve because of the excess weight. How embarrassing! Over the years I have become a yo-yo dieter - losing and gaining, losing and gaining. I have lost a significant amount of weight and improved my ability to exercise impressively along the way but always end up back to the ever increasing trend line - UP! Bottom line - I know it can be frustrating when people say “just lose some weight”, however, I encourage you to keep trying as the process tends to see your activity increase (a positive) and your nutrition improve (hopefully). Keep fighting and good luck! Anyway, I had an ablation in 2018!when I was up 65 pounds and it kept me completely afib free for 10 months and reduced my need for medication by half. Good luck!!

[Barb1]

My EP knew that I exercised as much as I could and was eating very nutritionally but still had a very high BMI. So he was quite happy to give me 4 ablations that gave me years of being in SR. It was only the 5th that was not successful and nothing to do with my weight.

[JOY2THEWORLD49]

Hi

When the private Heart Specialist discussed a subject that I brought up he gave me negatives.

1. 32 I think Obese

2. Age then 72

3. Length os having Rapid Persistent 2 years 3 mths.

transferred for indepth session re ablation. Told no for me as I have an enlarged chamber at the back. Although Xray said top of normal size.

I have never had a cardiconversion.

Maybe because I had a stroke which diagnosed me with AF and thyroid cancer.

Remember ablation scars the heart and there is a low but risk of stroke during the procedure.

Have you been tried on CCB Calcium Channel Blocker eg Diltiazem for high over heart rate? That was my saviour which got me controlled. Low Bisoprolol for BP control.

cheri JOY. 74. (NZ)

[Autumn_Leaves]

You don’t say how “big” you are but if your weight is impacting on your physical health, then I suggest you approach your GP or other healthcare professional eg arrhythmia nurse and ask about what weight loss interventions are available to their patients and who qualifies for help. It may well be that they don’t have much to offer or you don’t qualify because you don’t fit the referral criteria.

The next tactic would be to find out if they can refer you to a “social prescriber”. These are people who work with GP practices who can help look at the non-medical aspects of life that can impact upon your health. They may be able to advise on what exercise facilities are available in your area, or if there is some kind of healthy eating club or cookery classes. In some area the local mental health service offer 8-week or 12-week courses for people living with long term conditions that encompass many aspects of daily living. It all depends where you live and what’s available. It’s worth a try and there’s no harm in asking.

Health isn’t all about medications and surgical interventions. You really need to address the whole person and their lifestyle, and also examine the social determinants of health too. For example, when someone doesn’t feel safe walking in their neighbourhood they’re hardly likely to go out for an evening stroll if they feel threatened by the local neds. All manner of stressful situations can impact on someone’s health, and that’s where a social prescriber can help (at least in theory). So maybe start looking at what you CAN change, with support if you can find it, and with luck that will translate into weight loss and perhaps better cardiac function in the medium term, and hopefully make surgery a possibility. Every journey starts with one small step, as they say.

[Biglad1 in reply to Autumn_Leaves]

Was 220kg at heaviest and a truck driver so not overly active 15hr dayx3 & 2x13hrs sat most of the day, got down to 173 now down to 159kg with the aid of gastric balloon. Hopefully surgery next year.

[Autumn_Leaves in reply to Biglad1]

That’s a significant weight loss. You’ve done well. Don’t give up. You can do this.

[MummyLuv in reply to Biglad1]

congratulations on that weight loss! Keep up the great work

[Territorial in reply to Biglad1]

Great to see you have lost so much weight best of luck and good health..

[Popepaul in reply to Autumn_Leaves]

I liked your entry. A lot of veracity in the second paragraph. It is pertinent to us all.

[Biglad1 in reply to Popepaul]

Persistant