Ablation for all types of AF?

[OzRob]

I was reading a recent post - To 'ablate or not to ablate' by Tamgirl. Most responses were yes to ablation.

I ask this question of everybody on each side of the fence. Do you know what type of AF you have? Your type of AF may have had a bearing on your decision to ablate or hold of on ablation.

Vagal AF or Adrenergic AF? Does everybody reading this know which they have 100%?

Adrenergic AF is more likely during the day, Vagal AF is more common during sleep when the heart rate is slower due to the effect of the vagus nerve.

I have classic Vagal AF, I had AF almost every night which I could switch it off with a Vagal Maneuver, usually 2 or 3 times a night. And a PIP if I could not switch the AF off.

My AF burden was quite low but I had up to 800 PAC's and 400PVC's every night. I was wearing a nightly monitor for 5 months and tackling the beast as best I could without medication. The issue was my sleep was affected and I could not really keep up it up.

7 months ago my EP put me out of my misery and put me on 50mg of Flecainide and 50mg of Diltiazem morning and night. I have not had a single AF episode or Pac's or Pvc's since then.

I am booked for an ablation in October and my heart feels absolutely great. I can put a hold on the ablation and keep a holding pattern in the queue.

Did you consider your type of AF when making the Ablation decision?

Robert

[bean_counter27]

Each to their own but while my Afib is reasonably under control with medication i.e. not significantly impacting quality of life, then I wouldn't consider having an ablation. I presume you have been briefed by your EP about the pros and cons of ablation, including risks. The risk of major complications is small but why "roll the dice" unless you really need to?

Click on the following link if you want to read more about risks etc

melbourneheartrhythm.com.au...

[OzRob in reply to bean_counter27]

What type of AF do you have? Have you had an ablation or are you medicating?

[bean_counter27 in reply to OzRob]

Didn't know there were different types. I have paroxysmal Afib and untreated had a few episodes a month that usually went for ~10 to 16 hours. Mine is currently under control with medication (been 3 1/2 months since last episode which was <1 hour) and I've never had ablation. My cardiologist has raised the possibility with me but agrees that he wouldn't advise unless medication is ineffective. However, personal choice i.e. I could have ablation if I want it - noting that taking several medications twice a day is burdensome, especially when you've seemingly been very fit and healthy all your life.

[wilsond]

Either type eventually becomes more prevalent despite intervention, and the opportunity to have a successful ablation follows the same path. But it is a choice of course.

[OzRob in reply to wilsond]

Can you point me to the data where it shows both types of AF have the same end point?

Which AF do you have, and what path did you take?

[wilsond in reply to OzRob]

I had paroxysmal AF for several years,manahed reasonably well with meds and lifestyle, then rapidly and suddenly heading for permanent AF I also had Atrial Flutter .

It matters not what configuration of arrhythmia AF you have according to my EP Professor Osman,its the damage done eventually due to enlargement of the atrium,whether this happens at night ,daytime or both. I wondered if mine was Vagal and asked that very question you raise.

Best wishes

[Morzine in reply to wilsond]

Hi Robert,

Gosh that’s in depth, I hadn’t a clue about types, I did what the cardio said, took the tablets, it calmed it down totally once the tablets settled in and then he said in France we offer early ablation which was only the second visit, and I asked to wait till Xmas was over and said yes please and never looked back. I am not sure I’d have wanted all this information as it was a shock enough dealing with the afib happening….but some on here go into it with detail, others don’t, we are all diferent.

I would say why put off ablation? It’s a doddle, and worth it. You’ve a wonderful country to go out exploring and feel well!!!

Sue

[SeanJax]

ablation does not care of the type of Afib. To prescribe medication ep does take into account into it but not a lot. If your ep is an experienced one who already did more than thousands of ablations than go for it . If not try to find one who got such experience. My ep already did 12000 ablations. The success of ablation relies 80% on the ep. I mean by success no more drugs and episodes of Afib.

[Fullofheart]

If the cardioversion resulted in 3 days of nsr that should be long enough to evidence your heart can go back into sinus and should indicate to an EP that an ablation could be successful. That's usually what cardioversions are used for...not for long term impact.

[Bug146]

I had paroxysmal AF for a few years before it became persistent. Cardiologist insisted on medicating me, and would not refer me to an EP. Eventually got referral, and have now had 3 ablations. Latest one holding so far. EP annoyed with cardiologist, said if I’d been referred for ablation whilst still paroxysmal, success rate for ablation much higher. Every episode of AF increases damage to atrium, and makes ablation less likely to succeed.

[RVine3 in reply to Bug146]

Something similar happened to me - Cardiologist insisted on medicating me and not getting me into NSR, so when I saw EP via his referral months later, I was persistent and EP said gravely he was 'disappointed' (in the cardiologist) - and EP got me into NSR two days later with cardioversion - That was last January and still in NSR though antiarrhythmic often puts me in Bradycardia where I get dizzy, fatigued , so I am waiting for ablation in future. Confusing because cardiologist said I could try taking half the antiarrhythmic and/or get a pacemaker, while EP prefers to ablate. Good luck.

[Bug146 in reply to RVine3]

cardiologists are more interested in “plumbing” EPs are “electricians”! I had several cardioversion along the way, thank god for health insurance!

[JOY2THEWORLD49]

Hi

Your ECHO will measure your heart responses, size, workng chambers and valves.

My ECHO shows an enlargement of back chamber so I was told No to an ablation.

Like you Diltiazem controls my H/Rate Day. At night 47 avge.

I take Bisoprolol for BP control and I have a soft Systollic Heart Murmur.

I'm controlled without an ablation so walking more and more as time goes on and the Diltiazem now taken for a year has taken H/R down in 60s Day.

It is important to keep your B12 @ 700.

cheri JOY. (NZ)

[lizzieloo2]

I didn't know there were 2 types of AF other than persistent AF or paroxysmal AF. Mine is paroxysmal and I've had it for about 10 years now. To begin with, once diagnosed and medicated on 300mg diltiazem daily, blood thinners and 100mg Flecainide as a pill in the pocket, my episodes were about at least 9 months apart. They are now coming every 1 - 2 weeks and because of this, I asked to go on the waiting list for ablation about 18 months ago. I had always decided against it before because the burden was low. However, now that it is progressing and becoming more frequent, I have decided to go for it before it is too late for the ablation to have a chance of success. I was told by my first cardiologist EP that the disease would get worse and worse until I was permanently in AF, cardioversions would work only for so long and then I basically was going to die by the time I was about 70! I also asked him whether me having a sensitive vaso-vagal reflex would have anything to do with my AF as I often suffered episodes when I was younger whilst on holiday or out in a restaurant where I would get so hot that I would start to faint and would have to lay down while my heart thumped and jumped until I literally broke out in a cold sweat. He told me flat out no but from what you're saying, it could well have. That man upset me so much I was in tears after an appointment but luckily he left and my current cardiologist EP is great and I have confidence in him for my ablation which is schedule for 8 August.

[OzRob in reply to lizzieloo2]

What I find interesting is the lack of understanding here on the forum between Vagal AF and Adrenergic AF. These are what set off your AF, you have one or the other or a combination of both.

Paroxysmal AF and Persistent AF are your positions in the progression of AF.

Vagal AF is not as common as Adrenergic AF.

I think my post has baffled most people. If you follow me on the forum, I will follow up with a much more simple post to try and get more members to respond so we get a better understanding of Vagal AF and Adrenergic AF.

Robert

[KootenayTrails]

Hmm … I’d be interested in the definitive vagal vs adrenergic AF info you have. My EP Team is of the opinion that differentiating between the two is only important in terms of AF burden and medication choices. My understanding from them is that full EP studies (tilt tests, Stress Echo, heart biopsies etc) can determine over reactive vagal responses ie fainting/syncope or pre-fainting, which increases the AF burden significantly. My tests were positive for vagal AF, which really we already knew due to fainting episodes with AF. My EP kept me off Betablockers because of the vagal response. He said they can’t determine what percentage of my AF is vagal, that it’s not that cut and dried. He also explained that people like me go up quickly on the ablation list, especially when my AF episodes remained daily even on amiodarone (though amiodarone completely took away the fainting / lightheadedness/extreme high & low HR, it was a lifesaver). My first AF was Feb 6th, my ablation May 31st. I have not had one heart bump since, am back to moderate intensity cycling, pickleball and trail running, and am 4 days away from getting off amiodarone. I’ve only come across one medical paper on vagal AF from 2012, so I’d be interested in what you have. Good topic, thanks for bringing it up.

[OzRob in reply to KootenayTrails]

Thanks for the response, the best to date. What is interesting is that you were tested to determine that you had Vagal AF. Most people on the forum here don't know which they have, which leads me to believe that the vast majority have Adrenergic AF. Which would mean that most forum posts are slanted to that form of AF.

My EP said that as I had daily Vagal AF, and my AF burden was low I should still have an ablation as one day the medications would stop working. I am not anti-ablation at all, I am just concerned that anyone with Vagal AF who joins this forum are not made aware of the types of AF.

I also read somewhere that Vagal AF rarely becomes persistent AF.

Another factor in all this is what type of cardiologist is someone seeing, I had one early on that did not believe that I could switch off my vagal AF easily with a Vagal Maneuver, and he was an EP.