hi. I was diagnosed with af back in march after having episodes for around 12-18 months. As per usual they were getting worse and more frequent each time.
In march this year, it was actually caught on ECG at a@e hence the diagnosis.
Since then, I have had 2 echocardiograms (Nhs and private) both show I have a healthy heart (1 consultant said I have the heart of an 18 year old!!!)
once diagnosed, I was put on Bisoprolol and rivaroxaban. Initially 5mg of Bisoprolol but it made me feel light headed and dizzy so it was decided to reduce to 2.5mg.
In May this year I had another episode. This one was the longest lasting 3 days. I went to a&e as I was concerned about the length of this episode. I was then told to take 5mg of bisoporol half am and half pm. To date, I’ve not had another episode so fingers crossed I’ll be ok.
Spoke to a new cardiologist yesterday. He said it was my decision if I opt for the ablation or keep taking meds. I asked him if it was possible that the meds could keep it under control indefinitely. He said yes. I put it to him that most af cases worsen over time. He agreed yes most do but not all.
He told me that it was my shout if I opted for the ablation or continued the med route.
I’m on a waiting list to speak to the guy that does the ablations (approx 2 months) the op itself has a waiting list of 12 months.
Im fortunate to have private medicine that would actually pay for the ablation should I wish to go ahead.
My question is, should I go for ablation rather than keeping on the meds route? Would you say that meds was the first route and only if/when the af worsens then go for ablation?
My fear is, that if the af turns to permanent then the ablation can’t happen??
I only want the surgery if it’s totally necessary.
What do you all think??
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macymoo007
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It’s a tough one and has to be your decision. Do more research and pose more questions to your health team. Personally I think eventually the meds take their course, and further down the line you probably will need a procedure. I am a little biased in the fact that I have had two ablations( common to have two) and after the second one apart from the odd blip I do feel much better and for now no af. The “for now” is important because it is not a 100% guaranteed cure and is for quality of life only. So more research to do but for me ablation every time. Good luck !
Taking your paragraph .... "Spoke to a new cardiologist yesterday. He said it was my decision if I opt for the ablation or keep taking meds. I asked him if it was possible that the meds could keep it under control indefinitely. He said yes. I put it to him that most af cases worsen over time. He agreed yes most do but not all" .
That describes me perfectly. I was diagnosed with paroxysmal AF in Jan 2010, aged 65. My AF specific meds were 5mg Bisoprolol and Warfarin. Other members of my party bag of drugs were (still are ) Statins, Ramipril and Felodopine.
At the time of diagnosis Consultant discussed with me the way forward which included ablation. I opted for the meds route and have never regretted it even though some meds side effects have been errr .... challenging at times. But have absolutely no regrets. The other challenge with the meds of course is side effects, to what extent you suffer from them, to what extent the side effects are already on the list of known items (listed on the paper in the packet) and of course to what extent you have side effects that aren't already identified. Sadly you won't know that till you get into the meds. I'm fortunate, all my meds I tolerate very well and have no worries.
All that said ..... I am one of the fortunate ones who have accurately and successfully identified my AF triggers (food and ingredients of food). So my fight with AF has been a highly successful blend of meds and diet.
I'm now 78, still doin the meds and diet and have no intention of changing. Can't remember my last AF event certainly 18 months ago, maybe longer. No cardioversion, no ablation - just meds and diet. That said I was also fortunate that I had a great GP back in the day and he got me into A & E within 9 hours of onset and so that very prompt and accurate attention I got also prevented the AF getting to much of a grip on my life. I have had occasional ECG's over the years which update me on the state of my heart. The original damage to the Atria is still there, BUT, no better and no worse.
Its your call ultimately but with my experience in mind I'd give ablation a miss unless you have problem with meds or they just don't work.
I’m fortunate that I also don’t have any side effects. The only problem I’ve had re meds is that I’ve had to stop taking naproxen for my arthritic knee. It’s been a massive help more so than morphine amitriptyine and pregabalin which I take. So I’m struggling getting about. Even if I had the ablation, I’m told I’m on blood thinners for life so can’t go back on naproxen. 😩😩
I was diagnosed 6 years ago with familial PAV (inevitable). I was symptomless - it was discovered by chance. I take 1.25 mg Biso and Eliquis, and I although I check my HR morning and evening, I have had no events since the first couple early on. My annual visit to the Cardio has not picked up AF in all the times I attended, and for the first 2 years it was six monthly and I had the occasional ECG in my Gps rooms in between, I may be an optimist as far as this is concerned, but it does not appear to be getting more frequent. I'm 80.
Sure, I'll do that but as there is no way to save text on this (that I know of) I'll write something offline and paste it on here for you. Give me a few hours.
Here we go, apologies for the length but it gives the overall picture.
John
Once I identified the onset of AF with food I had eaten, and once blood tests had cleared me of IBS and Coeliac Disease I consulted a nutritionist and reviewed my diet. Following a course of Probiotics I immediately went gluten free, wheat free and oats free which helped restore some sanity to my ‘gut’ and reduced the massive bloating I used to experience. I also began keeping a food diary to discipline my thinking into identifying other foods that may be a problem.
Central to my story lies the fact that my AF events have been controlled, partly by medication and partly by diet, although I use the word diet loosely. It is probably more appropriate to refer to it as a food intake plan (FIP). These days, with the benefit of research behind me and a wide range of comments from other contributors on this forum, I see my FIP as a work in progress and it probably always will be. It really is a case of being constantly vigilant with my food intake and even today ( all these years later) I will eat something which my ‘gut’ finds challenging. It is a continuing process of analysing food, food ingredients and how my gut responds to what I eat. I have no issues with drinks – hot/cold and/or alcoholic or non alcoholic or ice cream etc.
So, in addition to gluten, wheat and oats, out went the typical English pub style real ales while some lager beers are fine, as are wines and some spirits. Tea and coffee are not a problem. Out went yoghurt, raspberries, runner beans, peas, baked beans, nuts like walnut, almonds, brazil etc. (yet processed nuts like salted cashews or peanuts do not seem to be a problem). Out went soft cheeses like Brie ( but hard cheeses like Edam and Cheddar are fine), all hot spicy food, msg, wholemeal or any grainy bread, roast pork, roast duck, onions ( yet spring onions/shallots are fine), all salad greens except 'Rocket', yet radish and watercress is fine. Tomatoes I can only take very infrequently. Jury is still out on eggs, but they are suspect, but it depends on the format – fried eggs are fine, scrambled not so, poached are fine too, boiled are fine. Oh yes, and I am now added sugar free too because I had a minor health scare which put me borderline pre diabetic. This was a real scare and affected me far more than my AF diagnosis because my father had Type 2 diabetes which eventually killed him. I nowadays self test my blood sugar at random during the year to ensure my Hb1ac reading is well below the pre diabetic level.
It isn't just these foods in isolation that are the problem I am also convinced it is how these ingredients of foods interact with each other ingredients. I have to say though, this all represents myself, others may be affected by a different range of foods and drinks in slightly different ways. Some foods now I am able to return to cautiously – dumplings with stew for instance. I do emphasise it has been a 13 year long process – BUT I am AF free, no cardioversion, no ablation but clutching my meds closely, and a very stable gut/digestive system ( so long as I’m vigilant ).
Wow that’s quite a list! More comprehensive than mine but I’m only 1 year into PAF.
Also some things like spirits, beer I am steering clear of ( non alcoholic beers are ok) and 2 glasses wine max. I am eating more nuts, salads and oats than before. Everyone is affected differently it seems.
You mention pre biotics, but do you have any fermented foods,drinks? This has definitely helped me and I am convinced there is a strong link with gut heath and AF.
Kimchi,Kefir and Kombucha in small doses with a high fibre diet seem to help.
Appreciate your list and some things to try thanks.
After so long now watching my food I am able to return to some foods that I abandoned way back in the years 2011 thro to 2020, but only recently. Nuts yes. Salads to a very limited degree but only because I steer clear of lettuce and tomatoes on a regular basis substitute lettuce with rocket. Tomatoes, large ones only, finely sliced and very very irregularly.
Fermented foods/drinks not at all ... as I said and even today still no Yoghurt. I have had this suggested before, given it a whirl but not for my gut. Kimchi,Kefir and Kombucha in any doses are upsetting for me.
I have to say over the years in a few idle random moments here and there I have been able to reflect and trace the onset of gut issues to around the age of 32 (I'm now 78) and much more severely in my late 30's and early 40's and although I persisted with foods when AF mugged me it became time to abandon many foods.
Then there is of course the question of genetics. Certainly on the paternal side of my family there is clear evidence of death by strokes and in more recent times diagnosis of AF, fortunately though, no death from AF.
What is most important is to understand that any and all treatment for AF is only for quality of life (QOL) in other words symptom control.
I am a great fan of ablation having had three for AF before mine was terminated but I still have arrhythmias, just different ones.
Probably the most important thing is life style. A change to a more plant based diet, weight loss where appropriate (BMI less than 26) no alcohol, less stress etc are all things proved to reduce AF burden sometimes to the point that other treatment is unnecessary.
I think the answer lies in an old proverb. When the pupil is ready, the teacher will come. I first rejected the idea of ablation but within six months my AF had progressed to the stage I was crawling over hot coals to see an EP (Electrophysiologist) and begging for an ablation.
I’m so fortunate that when I do have an episode it just makes me feel lethargic and short of breath for the duration of it. (Usually 24 hours but the last one was 3 days). My weight is an issue. I really struggle to lose weight. Being disabled is a problem in itself but to try and lose weight it’s a real problem.
I’d rather have af than go plant based. Sorry. Ha.
I can’t get my mindset to lose weight. It’s a real issue. I love my food
On the plant based diet, I think the operative part (BobD please correct me) is 'more plant based', not totally . That is, eat less processed food, and absolutely less carbs. Reduction of food in packets will mean more proportionately veg in the diet. This will also help against diabetes. This is all easier said than done though, especially these days.
I had to make the same decision about 9 years ago when I was 70, with my cardiologist advising caution against ablation and my EP willing but also wary. I opted for Flecainide and it has 'worked' for me so far, stopping the AF completely for those 9 years (so far, so good).
You need to research, research and research - and even then you'll probably be unsure. I think there is no correct answer as we are all different in our reaction to AF, the meds, intervention and our EP's are equally different too in their skills and methods. Lifestyle changes may help too - dietary by removing known harmful foods such as additives, weight loss if needed and supplements. I found psychological changes helped me immensely - mindfulness meditation, dumping stressful situations.
My cardiologist says that Flecainide is a wonderful drug for many people, but for others, not so effective. I know I am fortunate that Flecainide has worked for me and I'm glad I didn't push for an ablation until I had tried it.
Best wishes with your decision - it always has to be a personal choice.
In your case, ablation is not "totally necessary" by a long shot.
My two cents based on my afib journey is to ask for a trial off of bisoprolol entirely and see if that makes any difference. My guess it probably won't other than getting rid of its side effects That's because bisoprolol is a very weak anti-arrhythmic and basically for rate control.
Then I'd ask for a Pill in Pocket (PIP) like Flecainide to take for your occasional episodes. For me, it converts me back into normal rhythm in 1-4 hours, rather than waiting many hours of days to convert. Since you have a structurally sound heart, it might be a perfect drug for you.
As long as your episodes are infrequent, this strategy could work for many years, even forever.
As mentioned above, do research on ablations and also the minimaze procedure. With a healthy heart and fairly young age (61 per bio) success rates increase.
Have you worn a medical device heart monitor for an extended period to evaluate the AF ? AF can be silent especially in healthy people.
With increasing episodes, ask the doctor if a cardioversion would benefit planning a path forward.
thank you for your reply. I haven’t worn the heart monitor but I do have an Apple Watch that records any episodes. I can’t identify my triggers as yet. So I guess that would help me forward.
I am going against the grain here but I would go for ablation. If you read the research on the progression of AF, the evidence is that early treatment is best. slows it down and in many cases that amounts to stopping it. Early ablation for a “healthy” heart is the advice of the NHS AF team I see. The earlier the better!
My EP said that Bisoprolol was not the best way forward for those whose triggers are vagal and where a slowing heart after alcohol / food / deep sleep are triggers. Also the meds may have no side effects in short term but in long term? Many find beta blockers less palatable over time.
lifestyle is important of course but apart from going teetotal I had little to change, not overweight, very good diet, don’t smoke, can’t increase exercise due to orthopaedic damage.
The meds will always be available to return to but there is a time frame for ablation for a healthy heart. The old advice was the procedure was a last resort, this meant more complications and less success as the heart had been affected by the AF. So, new advice is the reverse. I had an early cryo ablation three years ago and after previous weekly 8 hour monster episodes I have had one two episode once a year. So, not eradicated but barely a feature. If I have more I will ask for a second ablation.
If you have one, don’t assume private is best. Research to find a very experienced EP in a well established team. The word on the ground was that my EP is exceptional but he does no private work. I was lucky - they so fast tracked early AF I only waited weeks not months.
Like you I have considerable pain issues and the avoidance of naproxen etc is awful. I do use gel and co codamol but nothing is as effective as an NSAID. Grrrr.
I’ve certainly researched the best person to do an ablation in my area. I’m seeing him through the nhs. I only mentioned privately due to waiting lists. It would be the same guy private or nhs.
I’m hoping the 2 month wait to see him gives me more time to decide which is the best route for me.
I’ve read LOTS that early prevention before the problem gets worse is best. I’ve also read that meds can control the problem for life so as I say I have a decision to make.
I am in the same boat. I have been on Flecainide and Diltiazem, 50mg of each morning and night for the last 6 months which has controlled the AF 100%.
I have Vagal AF which only occurred every night before the meds but was controllable with Vagal maneuvers or in worst case, a pill in the pocket.
Ablation booked in for October.
I asked my EP if I should just keep taking meds and only entertain the ablation when and if the meds fail. His response was that it is better to have an ablation before it gets to the stage where the meds fail.
Be interested what others think about his way of thinking.
The difficulty is that, although you were told that you have the heart of a sixteen-year-old (whatever that means), it isn't acting like a sixteen-year-old's.
The cause of most people's AF remains unknown and, thus, its progress or prognosis remain unknown, too. Given this lack of knowledge, all that doctors can realistically know is based on clinical trials, medical experience and guesswork. This seems to suggest that AF will, at some unknown rate (since its cause is unknown), likely progress to become more frequent and eventually, to be a permanent state for the atrium, always quivering away merrily.
What that progress will be like also remains unknown, not only with regard to how quickly it will happen, but, much more importantly, what it will feel like while it progresses. One of its effects in particular is important: the way the atrial activity affects the ventricles and the valves. For all (?), it causes an irregular pulse; and for many (?), it causes tachycardia. This, if it is allowed to persist, can alter and weaken the pumping ability of the heart (i.e. its ventricles).
Betablockers (or calcium agonists) can often control tachycardia, and are quite a safe means to do so, and sometimes, this alone will stop the AF, but not always as only some arrhythmias respond to rate reduction. Ablation aims to destroy the misbehaving conduction cells and pathways which are mostly around the pulmonary veins in the left atrium and it can control, even cure, AF and associated tachycardia. It seems to offer maybe a 60-70% success rate, at best and a quite high recurrence rate. It is generally very safe, but the pulmonary veins are a potentially risky area to ablate and can become harmed and partly occluded; also, the heart wall is very thin at that point so can allow heat conduction to associated organs (e.g. the pericardium and the oesophagus) and, for all, the septum between the two upper chambers needs to be punctured to allow access to the left side.
What's to be done for best? I always feel that trying to pinpoint the cause of the AF would be a good starting point, but maybe not since it's rarely possible to do this as the AF is the result of a long-term process, maybe even genetic; also, it's biology that determines that once heart cells change, they don't easily recover from those changes, and, more certainly, if and when they die, they can't regenerate or be replaced. But some known causes do seem to reduce arrhythmias if removed: hypertension, sleep apnoea, obesity, diabetes, thyroid abnormalities, excessive use of recreational drugs and alcohol, are examples often given.
I doubt that has helped, but I think I've covered all I know that seems to matter.
Hi,Just wondered when you say 12 months wait is it because you would be having general anesthesia as with my ablation it was 5-6 months with sedation and at least 12 if GA.I personally think ablation as it has worked so far 4.5 months.Only drugs Diliatizem.Any drugs have side effects.
You could always set wheels in motion and change your mind at a later date.
If your AF gets worse you won't have to start the wait later.
I have also been told by my EP that it's best nipped in the bud then left till later. Ablation has a much higher success rate with P-Afib then permenant Afib. It was explained to me why but I'm not sure I understood it beyond the fact that Afib is considered a progressive condition because as time goes by it develops more pathways causing more Afib. The technical boffins out there will explain this far better.
My mom has Afib and she is 87 and I have skipped beats (PAC's) and so I'm on 2.5mgs of bisoprolol. I am 66. I have read that having Afib and/or PAC's under control=meaning no skipping are IMPORTANT because the skipped beats are what causes REMODELLING of your heart (that's the pathways that you mentioned).
If the Afib or PAC's aren't under control then your heart will receive more damage DUE TO the skipped beats (which causes the remodelling-the new pathways and makes the heart bigger and then the heart has to work harder). So it seams to me, the better the Afib/PCS's are CONTROLLED the better because of LESS DAMAGE to the heart!!
So from what I've read it's best to prevent the Afib and PAC's with meds, cardioversion, diet, exercise, stress reduction and/or ablation. My mom has taken various meds, 2 or 3 cardioversions and one ablation done plus diet, stress control, weight control and lots and lots of exercise throughout her life (she is an avid walker and does strength workouts) and 2 knee replacements.
Yes I have been told that they are usually benign however, I have also read that skipped beats make the atria change in size (all skipped beats, if numerous, remodels the heart).
Here is an excerpt: Prognosis is dependent on the underlying cause of the PACs and the presence of structural cardiac disease. Many idiopathic PACs are relatively benign in the short term, although they can be associated with an increased risk of cardiac and all-cause mortality if they occur frequently.[43][44] Similarly, frequent PACs have also been shown to be associated with a greater risk of developing atrial fibrillation and atrial flutter.[45] Generally, underlying conditions play a more significant role in estimating prognosis.
Hi there , tricky one I know. Having been diagnosed with PAF in October last year I have had similar conversations with the cardiologist.
Just not quite ready to go for a cardiac procedure yet , so trying meds first.For me too I’m very fortunate that the diltiazem & flecanide combination are currently 100% effective, plus relatively few side effects, which I’d rather have than bursts of AF at 200-280 bpm.
I’ve been told that at some point the meds won’t be as effective but probably got 5 yrs + to wait for that. I’m a real foodie, love my G&T … however realised it needed to stop.
Long story short, losing 2 stone , off the booze & on regular meds are keeping the AF at bay so I’m holding off the ablation route for now.
Very individual choice, do your research, find the best EP / Cardiologist if you do go for it. All the very best, let us know how you get on. 😊
So far I’ve changed my tea to caffein free, my soft drinks to caffeine free and I haven’t hardly drank alcohol for a few years now. I only have the odd beer when it’s hot weather.
I know my weight is an issue. I have no willpower whatsoever. I eat healthy but it’s my portion control I need to get my head around.
I do some exercise but am limited to what I can do due to arthritis. My second knee needs replacing but it was decided to hold back with this due to me getting my 4th lot of blood clots post surgery even though I was on the maximum amount of blood thinners.
I always said that if my weight became a problem which could affect my life I’d be able to diet. I’m finding it ridiculously hard. I lose 10lbs then put it back on.
I do sympathise re weight loss. When you are not well exercise is more difficult so you do less.I found high protein with a lowish carb eating plan was the easiest and most effective. Eating protein satisfies hunger for far longer than carbs but we do need some carbs.
Portion control isn't easy if you are used to eating large amounts. Expect you have tried the smaller plate. Thing is a big drop of amount can be hard to do so how about lowering it slowly say a desert or tablespoon less for each meal. Once your used to that remove smother small amount. Have you tried that?
yes I’ve tried smaller plates etc and just about every diet going. I need willpower but find it hard. I hate being hungry. I’m a definite hangry person. I used to be so active. I played tennis, squash, badminton and in later life used to run a lot. I’m now on crutches with arthritic knees. (Most probably down to playing racquet sports) Call it an unhealthy relationship with food but I love it. I always have an excuse to diet tomorrow etc 😩😩😩
A Not easy. High protein is your best bet. Only the naturally slim says its easy. The rest of us are trying to find a balance. I eat far less than I did and now find I can't eat a big meal. But it happened over time. My weakness is sweet things... Lol
Yes protein is definitely very helpful and less carbs, but eating healthy carbs (whole grains, fruits - low glycemic, vegs and beans are key!!! Also carbs provide energy and help you to feel fuller longer!!
Yes weight loss is not the easiest. Fiber helps a lot because it keeps us fuller so that we don't want to eat as much (fiber: fruits, popcorn, beans, various other vegs). Keep at it, sometimes it takes a little time to figure out a good meal plan that works the best!! We all fall off of the food wagon now and then so don't beat yourself up. Just get back up and say it's a new day and do the best you can as you go along.
I began with attacks of Af months apart but it quickly got worse so that I ended up with it every other day and like Bob, dash to an electro physicist and had an ablation. This worked for me in a way as before, I was very symptomatic, but afterwards, the attacks that began again were relatively lighter. I lost 2 stones before the ablation to help control the problem.
I've been asked to have a second one to sort anything out that needs it but have out it off while `I think about it - it took me a long time to feel well. The flec and dilitiazem I take have stopped it since September and I'm enjoying the respite. However if things change I don't think I'll hesitate to go for another ablation. Hope this is of help.
My Afib attacks got more and more frequent and longer. They were always high rate. 165+bpm . I tried all kinds of rate control drugs eventually being diltiazem and an A/C. The 13th attack was 7 days resulted in 5 days in hospital, the last to days I the coronary care unit as I was 195bpm and I they could not get me out of A/f. The Ccu gave me intravenous Flecainide and I was back in sinus. I was then on permanent flec tablets.I decided to have an ablation that day. I had it 29th Jan 2018 and have not had AFIB since . I stopped all drugs in May 2018. With hindsight I should have had an ablation after my first attack, and saved 2.5 years hassle of afib and drugs and hospital visits. The man who eventually became my EP told me after my first attack, that it would return.He was right.
I’d say get on the waiting list for ablation. There is no harm done if you decide to cancel within a week or two, someone else can take your place. My A F progressed to persistent quite fast and I am on a 7 month waiting list. Having had successful open heart surgery in 1968 I’m not afraid of a comparatively non-invasive procedure like a catheter ablation, but then it does seem to be my only option. Good luck!
Macy, hi, I am also new to the world of AF and on my own journey presently. Medication the same as yours, just bigger dose of Bisoprolol. I have also looked at ablation as a possible treatment and steered away from it. It is a treatment once undertaken cannot be reversed. It would be my advice that you look at the other options first, keep healthy, healthy diet, reduce alcohol and keep taking the medication 💊
I think if you poke holes in veins, thread catheters into the inside of your heart, poke a hole in the septum of your heart and deliberately damage areas of the inside of your atria that it would be called a surgery. Let's not label castor oil as maple syrup!
Well you have some wonderfully informative replies to help you consider your dilemma.
I was contemplating an ablation, edging away from the fear of surgery , then went into permanent AF, so I opted for one, for the reasons explained. You research it to death , but never know for sure …..Also, I was tired with the meds, “in out, in out, do the okey cokey”😀 and it feels like it’s taking your life over and other’s. It was a bit like the coins on tipping point…..
Unfortunately I have never seen anywhere the stats as to what percentage of ablations are successful and if deemed 'successful' what does that mean eg no episodes for just a year, is one comment I have seen! Personally, I regard 'success' as no episodes no drugs for 5+years.
However from what I read here (maybe only from those that haven't worked) I hear too many issues with ablations and therefore I would only have one if my Quality of Life was poor and I would know that as I wouldn't be asking questions I would be gagging for it.
The ablation can still happen if you go to persistent. I'd been persistent for about a decade when I had my first ablation. It is only classed as permanent if you and your medical team agree that further surgery and/ or medication is unlikely to change the rhythm back from AF into NSR.I had three ablations last year and very unexpectedly 5 months after number 3 I am in NSR, after they had diagnosed permanent AF and heart failure at 47 (bit of a shock). We were looking at pacemaker further down the line (they wouldn't do at my age) and heart failure meds alongside rate control meds for short term. Quite something to go into NSR after that, whilst not on any meds at all! A nicer shock!
As a non medic, but having had lots of conversations with them over the years, my understanding and my experience is:
Medications might not work forever but ablations are the same. You will potentially need another at some point. If your heart is healthy, you are in a good place and that takes away the sense of urgency that many feel if they, like me, have experienced significant decline in heart health. I think it's about quality of life now in your case, and whether you a) tolerate the medication well and b) they work for you. Plenty to think about, but no rush by sounds of it.
The only medications you are on at present are the rate controlling ß-blocker and the anticoagulant Xarelto, both effective for what they do, but not so much for rhythm control. There are several antiarrhythmics available which would better serve the purpose of better controlling the afib.
In my particular case, increasing doses of the ß-blocker atenolol did NOT control the frequency of afib episodes at all, and they were up to 27/month at its peak! Following definitive (ecg from Kardia) diagnosis of afib, I was put on the rhythm drug propafenone (along with anticoagulant and continued ß-blocker), and following adjustments to the dosing, for the past 18 months I will have a short (<2 hr, sometimes 10 minutes) episode of afib every 6-8 weeks. I can live with that! I realize that this fix may not be forever, but over this time span episodes are decreasing (keeping fingers crossed).
If I were in your shoes, I would pursue more aggressive medications before I would EVER consent to an ablation. From what I have read and heard, ablations are a very invasive procedure, by design they damage the heart, recovery period can be many, many months (the "blanking" period), and success is anything but assured. "Touch up" procedures are the rule of thumb it seems.
Definitely your call, but with the variety of medications available (some of which work, some of which don't) I would be a LONG way from considering ablation.
total agreement! I was diagnosed with PAF 10 + years ago and have been on medication (warfarin, Diltiazem and flecainide) since. Recently episodes have become more frequent and longer but they don’t bother me unduly. My cardiologist said he could refer me to the EP but if AF is not bothering me then he feels ablation is ‘unnecessary’ but ultimately it’s my call! He also said that if AF became permanent, and it’s not causing problems then it could be acceptable to live with it. My latest echocardiogram reported a very heathy heart. If it ain’t broke don’t fix it!!
l was given that choice as well. My decision was to remain on meds which controls my afib fairly well. No way would l allow a surgeon to cut into my heart. I found that concept terrifying. I wish you the best. Most on here who have had ablations say that they have had to have additional surgeries.
I think the replies are 50/50. The thing I have to do the most is research. I’m loathed to have ‘the procedure’ as it can cause blood clots and/or stroke. I’ve had 4 lots of blood clots in the past and don’t want any more. I wish I could find out the trigger to mine. It’s not alcohol and not stress (I had a very very stressful incident 3 weeks ago and I did have alcohol at the start of that) neither triggered it. Still on the fence
At the end of the day it's all about quality of life. Ablation is no magic wand but it's an option. My meds were not improving things- in fact I can say that they made it worse.( Flecainide and Biso ). Ablation in 2018 am I have a better quality of life. But of course one can't take anything for granted. AF is complex - I can't spend the rest of my life looking for the triggers. I wish you well.
For what it’s worth, I’ll share my personal story, as having an ablation gave me back my life. I’m a 69 yo female and had paroxysmal af for 2 years, about once a month. Each episode was incapacitating. I would have to stop everything and lie down until the episode ended. My husband is a retired cardiologist and despite the severity of my symptoms, he was reluctant to recommend an ablation. Maybe my electrophysiologist was extraordinarily good, but in any case, I have not had even a minute of a fib since the ablation seven months ago. No more anticoagulants or other heart meds because since I am hyper sensitive to a fib symptoms, I know immediately when I’m in it. I also wear an Apple Watch that would detect a fib just in case I don’t. Thankfully, since the ablation, no more wondering if I can go through with commitments because of an a fib episode. In my case, it was the incapacitation from a fib episodes that caused me to opt for the ablation. If my relief only lasts a few years, I would not hesitate to get another one. But that’s just my personal story. Everyone is different.
since you are not in sustained AF, I would stay on meds only. Also if there is a good antiarrythmic drug in addiction to the ACE inhibitor. My son had a cardioversion several months ago, is on Elequis and has done very well. Thank God!
It's a tough decision. I had AF for 10 years with very infrequent bouts 3-4 times a year lasting 2 hrs pretty exactly.My history reveals how treatment advice changes.
At the time I had Verapamil as a pill in the pocket and a daily Aspirin which wrecked my stomach (both no longer recommended btw). I felt really drained when I had AF and afterwards, but GPs seemed not to be bothered so neither was I.
But it all changed in 2016 when the AF started one day and just didn't stop. It was really scary. The slightest exercise sent my heartrate really high and irregular with long pauses.
Flecainide and Bisoprolol (with Apixaban) helped but didn't stop it. A cardioversion lasted a couple of months. But this is the thing - because I had been in persistent AF for 5 months before both ablations it was harder to treat because some remodelling had occurred.
The second ablation which treated far more areas of the heart worked better than the first. I have very few and very short episodes now, which I hardly notice. But I still need the meds, which at present work well keeping AF at bay. (Although my EP says he doesn't really recommend Flecainide after the age of 75)
The recovery from the ablations was rocky, but on balance I wish I'd had them earlier.
hi. Thanks for your reply. I guess I’m really unsure as my af isn’t affecting my quality of life at the moment. My fear is that it’ll worsen to the point where ablation isn’t going to be that successful, or, when it won’t be an option. I’ve read early prevention is best but I’m also aware that medication can control without the procedure.
Over the years I’ve had a couple of major surgeries and my body doesn’t tolerate this. I’ve developed blood clots which have been scary and debilitating. My last cardiologist says these pulmonary embolisms aren’t the same as the clots formed when in af but I’m not sure.
I don’t want to put my body through ablation if I can help it.
No one's body really tolerates surgery. It's an invasion and only good if the benefits outweigh the risks. Might making a list of those help you choose? For the NHS (for now) someone somewhere has decided that the expense of Ablations is worth it to offset the greater expense of treating strokes associated with untreated AF. But that's for the population as a whole, not individuals.. You are obviously becoming more bothered by the AF. But if you can control AF with the medications to prevent it becoming persistent that's possibly a good option for you. Bisoprolol works for my husband and also has the benefit that reduces anxiety.
Not me. I needed an anti-arrhythmia drug too hence the Flecainide. My only reservation with the anti arrhythmia drugs is that they are supposed to be toxic, although I haven't experienced major side effects so far. Fingers crossed. Bisoprolol can be debilitating too.
I only wanted to say that he change from paroxysmal to persistent was sudden and unexpected. The ablations still worked after a fashion, and probably would have been more effective if I hadn't had to wait 5 months with my heart electrics remodeling. I too have "healthy" heart in terms of pumping action. It's the electrics which are faulty - like yours.
Why not see the EP - the ablation specialist and get their opinion? Then - as a few people have said already- if you are on a 12 month waiting list you can always turn the ablation down if you are coping well. Just a thought.
I think that’s the road I will take. Get on the list and see if there’s any change while waiting.
I am due to speak to one of the top guys that does the ablations so again, I’ll be partly guided by what he says. Ultimately, I believe the choice will be mine.
While I’m doing fine at the moment (on 5mg of bisoporol along with Rivaroxaban and no side effects) I’m more than aware this can change for almost no reason at all.
The current recommendation is that ablation is carried out asap. But it's up to you. Document your episodes. Duration, highest heart rate, meds, how you feel, an ECG (buy yourself a kardia mobile monitor) and take these to the EP appointment. Also if you decide to do the ablation make sure the secretary knows that you're available for a cancellation, if you are. I had an ablation in Dec, nsr since. Buy the AFib cure by Dr John Day and Dr Jared Bunch available from Amazon and elsewhere. Great information in it.
Don’t think about it…. Go and have the ablation asap. Being on constant meds is no good for you. I too was on Riveroxban and Bisoprolol. Had my ablation on the 18th May. Have just been taken off all meds. Fingers crossed, all will continue to be well.
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That's because bisoprolol is a very weak anti-arrhythmic and basically for rate control. 
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