In my twelve years living with Afib, every Cardiologist I have seen ( including an EP I saw, for a second opinion ) have told me, that Ablation should only be a last resort. My first Cardiologist in Florida, going so far as to say " do you really want them to burn holes in your heart?"
So I am curious why everyone seems to think that Ablation is the cure all for Afib ( it is not ). If medication works for most people, why should you undergo this procedure that actually scars and deadens areas of your heart.
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Budken
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I don't think that everyone on this forum thinks that ablation is a cure for AF but many people have extremely miserable symptoms and/or cannot tolerate the antiarrythmic drugs needed to control their symptoms.
There are also many patients who prefer not to use powerful drugs for life, knowing that eventually their AF may well worsen and break through the drug therapy.
I do take your point about intervention and scarring in the heart - but that is only one consideration amongst many when an individual is considering the best therapy to control symptoms and improve their quality of life. I chose the drug route 9 years ago and am happy still to be AF free but I am 79 and would probably have chosen ablation had I been a couple of decades younger at diagnosis.
Hi Rosie - I have been taking 2x100mg Flecainide and 2.5mg Nebivolol daily - together with an anticoagulant. I was started on Bisoprolol but had too many side effects so was switched to Nebivolol 5 years ago.
I was exactly the same. Refusing ablation, Flecanide plus Nebivolol. Great for years then AF broke through and now have a Pacemaker and had an av node ablation. It caught up with me in the end.
It has been a little up and down. They discovered I’m now in AF 100% of the time so they switched off one lead and reprogrammed the pm. After that, great. Can’t feel a thing.
Oh wait. I’m confused- so having the av node ablated does not keep you away from AF? Are you saying that even though you now feel fine that you are still AF? Most confused here on my part 🤠
No, a PM doesn’t stop the AF. So I was told when I was offered one. When I sought a second opinion before going ahead, I was told it wouldn’t stop the AF and it would rattle on relentlessly and I’d be breathless on exertion. So thankful I got a second opinion. I had a successful ablation two months ago and so far have had NO afib at all. 👍
I originally took Flecainide 50mg twice daily with 25mg Metoprolol. Then after seven years of not a single episode I had some short outbreaks. My Cardiologist at the time told me to either take 300mg pill in the pocket, or just double my daily dose. I chose that, as taking 300mg at once scared me. Then a year after that, I had intermittent oubreaks again. By that time I had moved to North Carolina, where the Cardiologist there, said he thought the oubreaks and PVC's were caused by the Metop. He questioned why I was ever given it at all. Said it can cause all kinds of problems. Once I stopped taking it ( that was a scary ride ) all my ecopics stopped. To the point that my Cardiologist here in Germany said to stop altogether. I tried that, but had one all day episode. Just went to my GP and she suggested I go back to taking a daily dose of 50mg. So far so good.
it is your choice to make depending on how miserable you are. It can at least give you a sample of what you will be like without a fib if it works. I had my first one. It worked 3 1/2 weeks I will tell you it was an incredible 3 1/2 weeks. I had a second in December of last year it failed even though they tried three times they are a bit like a Band-Aid. You never know when they will fall off if they stick. I hate to be a Debbie downer, but I personally would not do it again after the failure, nor did my doctor ask me to. that was the last attempt to reset my arrhythmia. I had heart rates in the 150 for almost a year. My heart could not take any more. I’ll cut to the chase. I know have a pacemaker made for me in regard to wiring. It’s the best thing I could’ve done although there were days I would have said different. They told me six months to a year for healing, and I just hit my six month mark and my quality of life regarding my heart is amazing. Lol now the old car is falling apart. Having stomach issues but let me tell you, I can actually not think about my heart anymore where is since diagnosed with a fib it was all I could think of. It is a very long road they do not just pop one end and you are all better and you will still feel flutter and a fifth at times if it should act up. I had a little flutter yesterday, first time in weeks. The difference with the pacemaker is it no longer harms your heart when you have flutter or a fib because of the AV node ablation.😊
amiodarone is not for everyone and I’m surprised they want to put you on it before the cardioversion. I was put on it after my ablation the first one and I suffered for four months on it trying to stay on it to give it a chance to keep my heart Rhythm straight I finally had to go off of it. I was so sick. I needed another ablation six months after the first that lasted a year. Just remember there are no curious. There are temporary fixes for most of us. Best of luck whatever you decide some people have no problems with amiodarone.
Ablations are reported to be more effective in AF with relatively recent onset, but you have to look at the whole picture. AF can have various causes, including other pre-existing heart conditions but for others their heart function may be relatively good. Age, other unrelated medical conditions, overall fitness and body condition also need to be taken into consideration. Some people may not be good candidates for surgery. Other people might have infrequent episodes of AF and can get by on minimal medication, so the risks of surgery are probably not worth it in their situation. With all medical interventions it’s a case of weighing up the risks and benefits.
My Cardiologist has told me that one of his largest groups of patients is canoeists - I think the frequency of the condition extends to other more extreme sports. My son , a white water rafter, canoeist, hiker and mountain biker, had an ablation 17 years ago and has no repetition of symptoms since, and I think that also applies to his friends who have also been ablated, so it certainly would appear that the younger and fitter you are the greater chance of success (my son was 36).
Yes, that’s a good point. Younger age probably increases the chances of success. Obviously I don’t know for sure, I’m no expert, but I suspect that AF in a young and otherwise healthy person who does extreme sports or is physically pushing themselves has a different set of causes and risk factors from the AF that occurs in older adults.
I imagine so, but interestingly - we will wait and see what happens in my son's case (I probably won't be around to see) I have familial AF, my 4 sisters have it and we suspect our father had it. We were all diagnosed in later life and I wonder if the genetic aspect presents a predisposition for it in sportspersons - none of his cousins are ultra sporty so I am not aware of them being affected, or if it will genetically return in him in his later years.
Yes. It crossed my mind that as both you and your son both have experience of AF that there could be a genetic component at play. I have no knowledge of any of my family having AF but that doesn’t necessarily mean it’s not there at all. I have only a very basic idea of epigenetics but it’s incredible that our genes can be turned on or off depending on environmental influences.
Yes, there is certainly a familial variation, in fact, I have a list of the genes involved. If you are interested, I think you can Google 'Familial Atrial Fibrillation' and you will see the list !
There are different types of ablation. The one commonly done on younger, fitter people is a sinus node ablation, whereas I recently underwent left pulmonary vein ablation. That’s where they burn off the misfiring nodes just inside the pulmonary vein where it enters the heart. I only know all this cos my (fit) son-in-law (and a few of his fit friends) have undergone the former.
Thanks for that information.My son had his 17 years ago in Cape Town. I wonder if they differentiated then ?I must ask him if he knows what his was called. When mine was diagnosed 7 years ago (I was 73) I asked the Cardio who was the fellow who sent my son to Cape Town (we had no EPs in KZN and now there are only 2), and was a fellow canoeist and friend of my son 's, if I could have an op like Jeremy's. He said no I couldn't, besides I was managing perfectly well on the pills,! so probably it was because he had a sinus node ablation! He did a cardioversion on me instead , because I have asymptomatic AF and happened to be in arrythmia, on that day I went for a check up.
We have to be aware that there are many different ablation procedures and I’ve learned to be discerning when reading some posts on here. All our situations are completely different- age, weight, lifestyle, AF symptoms and causes.
My son-in-law suddenly developed a HR well over 200, which is a sinus node issue and is completely different condition from PAF.
Oh Lord., I’ve just googled tachicardia and there are quite a few different types.
I think he had SVT. “SVT is always more symptomatic than sinus tach. Sinus tachycardia has a rate of 100 to 150 beats per minute and SVT has a rate of 151 to 250 beats per minute.”
When I had my first ablation in 2011, I honestly thought it was going to cure my dreadful AF attacks - it didn't (but it did stop my heart from banging in my chest when I walked up hills, I had no idea that other peoples hearts didn't do that). Nor did the second ablation help, but the third did and I'm so glad I had it. My attacks would see me spending days in hospital feeling dreadful. I once had to fight to keep conscious.
I guess it depends how bad your AF attacks are. I'm still in constant AF but with a rate of just 60-90bpm at rest, mostly in 70's and I can cope with that.
I'm just like you Jean 3 ablations made it more tolerable but I'm still in almost constant afib though not as noticeable as before the ablations.A couple of years ago I had a stent and now
Lately I've been diognosed with heart failure left distolic disfunction so new drug for that.
If ablations had been available when I first got afib I would have jumped at the chance to have it but unfortunately it had progressed to permanent by the time they were available in New Zealand.
It sounds as though you've had quite a lot thrown at you lately. Sorry to hear you now have more pills to take. I too hate taking tablets but feed myself with 'health' pills. Sometimes I think I should just stop taking them all. They were all upped when Covid came but I still caught it!
I was first diagnosed in 2013 with PAF having been passing out frequently over the previous few years but ecgs not picking up the AF until I was hospitalised for a week for investigations. I had an RF ablation in 2018 following a further hosp admission and was great until last year when I caught covid and when into atypical atrial flutter which latest 6 months but resolved after multiple different drugs were tried. I eventually had another ablation during OHS for AVR and fitting of Atriclip earlier this year and so far, touch wood, I'm still in NSR and I've very grateful to now be asymptomatic.
Cat04. So you can get the Atriclip in UK? I have been reading all about it here in US when the amazing Dr Randall Wolf does it at DeBakey Heart Inst. in Houston TX. I am pursuing this for myself! I assume you are totally happy and would you say that the Clip has made you AF free? And has the clip allowed you to get off blood thinner? Many thx!
The clip doesn't make you AF free it just stop clots forming in the left atrial appendage. I wasn't given a choice my surgeon just said he would fit one whilst he was in there fixing everything else. If you are having open heart surgery you could ask if it would benefit you to have one fitted. I'm still on Apixaban as who knows when AF may strike again, sometimes you might not even be aware of it, and if a clot forms the consequences can be devastating.
In AF regime, there are uncontrolled electric impulses coming from certain foci in the heart. The MDs, performing an ablation, are happy if they are able to identify these foci and to "burn" them and the paths of the rogue el. signals. BUT... when you burn these foci, the tissue of the heart generates the new ones, with the same "disturbing" function. For this reason, it is sometimes necessary to have up to 8-9 ablations, to have satisfactory results. If the MDs were aware of the thing, they would burn all the risky areas of the heart in one procedure, disabling the heart to get in AF regime again. BUT... they obviously are not ...
It must be clearly understood that any and all treatment for AF is only ever for quality of life (QOL) and there is no best treatment but for many many people drugs do not control it or have such bad side effects as to be worse than what they are supposed to be helping. For those ablation can and often is highly beneficial.
I think it interesting that you refer to cardiologists and of course these plumbers seldom approve of the electricians (electrophysiologists) who perform ablations. After being AF free since 2008 I confess to being a fan.
l will always trust a "plumber" over and over priced "electrician". So many of them are in it for the money and little else. ( according to two of my cardiologists )
Untrue in my big NHS teaching hospital. Ablation for AF fast forwarded. No £ gain to my EP who is brilliant. My ablation transformed my AF to one mild brief attach a year from weekly monsters
Only in America! here in UK there is no profit in an EP suggesting ablation (they are salaried not paid by results or how many patients they get in ) so you can be sure that if they do they think it will help.
I undertook lifestyle changes on diagnosis. Helped a lot. After an extended period of high personal stress looking after both sets of parents ,a son having a nervous breakdown and a house disaster ,I gave up full-time work on ill health after a TIA.
Helped a lot,with medication as Pill in pocket .
AF and Flutter returned and I ended up in resus and medication was upped to daily maintenance dose.
OK for quite some time, several years.
Ablation had been discussed but joint decision made ( partly due to Covid and aftermath) to watch and wait. AF and Flutter got the upper hand, medication was largely ineffective and I had 2 x 5 and 6 weeks of continuous continuous very symptomatic symptomatic AF and Flutter.
I had my double ablation last year and have never regretted it. No Flutter since ,which was my worst arrthmia. The success rate for this is 95%+,do you not think that is worth doing? Medication never ever touched it in full blown episodes my heart rate in the 200s.
I don't think your post is very useful to those who have tried meds and lifestyle,and is rather sweeping and generalised.
I am under no illusion that AFib has gone forever but quite sure my flutter has, and other arrhythmia have similar results.
I didn't rush my decision!! . At every juncture I was informed of the procedure and I had lots of time to consider what was best for me. I am now 2 years AF free after a sucessful cryo ablation x4 PVI and have never regretted MY decision.
I also have concerns that the NHS having invested huge amounts of money in equipment and training may have a tendency to over sell the treatment as justification for the investment.
I struggle to see any reason why the NHS would "over sell" any treatment. For all its faults, including the bureaucracy, inefficiency and long waiting lists, all the NHS doctors I have seen (sadly quite a lot in different specialisms) have just been interested in doing what they think is best for me
Suggested to me as a thought to consider by my original Cardiologist (who at that time was considered to be one of the UK's leading arrhythmia experts), when making any decision. I think it would have been foolish to completely disregard his advice. Other of course, may have chosen to ignore it as a possibility.
I can say for certain that I was enthusiastically 'over sold' ablation by my then GP which was later brought down to reality by the Cardiologist . I trusted his opinion in preference as he was someone who actually carried out the procedures but its always good to have a broad range of opinions before an important decision .
Exactly. It’s the EP cardiologist who would discuss the appropriateness of an ablation with you and not the GP who as primary care, would have no interest in over selling to justify the investment.
Or could be viewed as having invested in this procedure, the general impression has been passed down to GPs that its 'all good ' but the Cardiologist with hands on experience had a more realistic opinion. Non of us will probably ever know which but personally I prefer to at least consider all possibilities
I am 51 with a young son and I’m unable to take medication due to low resting heart rate and blood pressure so my only choice was, live with it which was impacting my life or have an ablation, I chose an ablation which was fantastic, some of us don’t really have a choice not to have an ablation if we are very symptomatic and unable to control it with drugs 😊
I was not talking about cases like yours. I was talking about the people who have healthy hearts, but insist that ablation is the only "cure". Fact there is no cure, yet.
No there is no cure you are correct, some people just don’t like to spend their lives taking medication when there is a possible alternative that can give relief from the symptoms of AFib. Long term medication can also cause issues 😊
I understand what you are saying, but some of us, even with healthy hearts, minimal episodes and tolerable medication, are impacted greatly by the burden of Afib. It can cause untold anxiety and fear and can limit people’s lives massively, even without episode’s happening. Ablation gives hope to lots of people that they may be able to live a normal life, even if for only a while - but there’s always hope it will be many years.
It’s very easy for a cardiologist such as the one you met in Florida to make the sweeping statement he made when he doesn’t have afib, but if he experienced Afib himself and the impact it had on his own life, he may feel differently.
The medical profession is equally divided. First, bear in mind that many cardiologists in hospitals have their 'bread and butter' income from ablations which are relatively minor procedures and take little time. Second, if the procedure is successful then the patient needs no longer to be treated with what can be very expensive drugs.
But I have always been told that if you are in permanent AF and have been for some time, the success rate for ablation is very low indeed.
To support your view, Dr Sanjay Gupta in one of his videos says that the actual mortality rate and outcome for those with successful ablations and those who continue to take drugs instead which give control, is no different. The likelihood of going on to suffer heart failure or other circulatory ailments is about equal.
In the end, it is for the patient to choose, not be pressured in one direction or another. But if your quality is life is very poor with the drug regime, or you have to keep changing from one to another, then it is understandable that many will have recourse to ablation or similar techniques.
As has been said it all depends on the INDIVIDUAL.
I have a cousin in Germany and 4 years ago she had a successful ablation having had rapid tachycardia 😁.
At around the same age, I was offered an ablation but chose to try the drug route first. One of the key factors in that decision was like you mention the burning process did not appeal, too medieval like for me 😱. This route has also been successful for 10 years and counting.
A third option is supplements and lifestyle changes only.
I had just gone into permanent AF and was tired of the medication. My EP said he could not guarantee he could make me feel better, but he did say my heart would go saggy over time if i continued in AF/meds.
So, I opted for ablation 16 months ago. Who knows if I will need another, but it just felt the right decision at the time and the local Cardiac Nurse team though so too….
Presumably your medication regime works for you. That's the short answer. Had mine done so I wouldn't have had the ablation. Life had improved considerably since then though I still live my life knowing I have a heart condition.
The cardiolgist I saw after my first AF attack warned me that AF would almost certainly return, although it could be 3 days 3 weeks or 3 years, even though I was on rate control drugs, and the high rate 165bpm resting would be a feature. He told me what the different drugs did ( although I did not fully understand), and also described ablation. I was not keen on drugs, but abalation was "over my dead body"! However 20 months later after my 13th AFib attack all high rate, the lastup to 195bpm resting , lasting 8 days, 5 in hospital and only getting out of AFib by flecainide infusion in the Coronary care unit, and having learned about atrial remodelling, and having seen my attacks get longer and more frequent ( following that pattern, - the more you have afib, the more you will have it) I got in contact with that cardiologist, who is an EP, and asked him for an ablation. 6 months later I had it , 5 years 7 months ago and I have not had afib since! I really wish i had one after my 3rd afib attack, as I could have missed out a lot of hassle and avoided a stressful horrible 18 months and avoided poisoning my body with all the different drugs I took!
Additionally there have been several studies in the 8 years since have had afib which suggest early ablation is more likely to be more succesful.
Also although I was 57 years old when I had the ablation i was fit, healthy and had no other co morbidities which helped make the ablation succesful.
Your situation sounds much like mine. I was diagnosed in 2010. Took flecainide for seven years, then had a few outbreaks. Doc took me off the accompanying Metoprolol and they stopped. Have had only one outbreak since.
Budken. Curious if or why the Removal of metoporal helped. It is for rate control is it not? Seems like AF is a rhythm issue (mainly) …..but I may be wrong….🥨
I call that lucky! After reading the many threads on here where folks discuss their multiple ablations, and ablations that failed, and ablations that made them worse.
I sooo wish there were more stories like yours - though of course most of those folks are out there living their life and not on this forum 🙂
I was diagnosed with PAF in 2021 was put on medication which didn’t help then had two cardioversions which also didn’t work my cardiologist then tried me on different medication but was also trying to get me to see an EP to see whether I was suitable for an ablation but I kept refusing so I said I would manage it. That didn’t last long as my symptoms got worse and my quality of life started to deteriorate and at the time I was only 58. so in November 2022 I had my first ablation but unfortunately for me my symptoms got worse so June of this year I had another ablation which so far has worked now I don’t know how long it will stay like that but for the moment I am not getting any symptoms of Afib and I know it’s not a cure and that an ablation isn’t for everyone.I turn 60 the end of the month and we are taking our family away so will be nice not to have to worry about going back into Afib.
I had been in persistent AF for a year and was concerned about the stroke risk which is why I pursued the ablation option. The ablation was performed successfully but immediately afterwards I had a TIA (very minor stroke) which is a 1 in 500 risk. I recovered from that overnight and have also been Afib free for four months. Did I go down the right route? Who knows? Life is a lottery and the only certainties are taxes and death. It is a personal decision and there is no absolutely right or wrong answer.
You say that you had an ablation to prevent a stroke, then had a TIA . A TIA is an event or warning of a stroke in the future. That's why you take an anti-co-agulant.
Ablation is new, it scars your heart and there is no going back. You have just one heart.
Do think carefully when AF returns. It is usually a temporary time.
Yes I had been on rivaroxaban for the best part of a year, in fact they are not keen on doing the procedure unless you are on anticoagulants. It is very rare for this procedure to trigger a TIA, 1 in 500 chance apparently and the surgeon and registrar had never experienced it before. Just my luck I guess!
Everyone seems to want more and more - pushing for cardioversions and ablations.
Even antirhythm drugs are risky.
Controlled on CCB and low dose BB I am glad I didn't push ablation.
As you say it is mostly scar and wait and see.
Structurally examined first if any abnormality is found all these are a no no. So wait for ECHO or MRI first.
I say poor hearts are undergoing horrendous procedures without careful consideration.
I'm in NZ and ablations are done only when structural abnormalies are ruled out.
Also the patient actually is confident with it all. You are all guinea pigs actually and one day every procedure will be easy, accurate and a fixer. That's what I believe.
I completely agree with your post and would also add that when my own AF became permanent I was surprised how quickly it settled into something that I hardly ever notice unlike the PAF attacks before that would debilitate me for a couple of days and take a week to recover from. I dont have any idea if that's a common occurrence but the only other person I know personally with permanent AF has exactly the same experience. Perhaps like tinnitus and habituation?
I was found to be in Rapid Persistent at time of Stroke. So I've never known "come and go AF.'
But they found Papillary Thyroid Cancer within 4 days in there.
I never felt it rapid bur sweating and fatigued is the reason of H/R of 187 and then 156 was apparent with little energy.
The DHB put it on the Thyroid problem but it was the uncontrolled H/R and I was left.
I finally under a locum's referral ventured out to private consultation. There I was tried on CCB Calcium Channel Blocker. It saved me and a great reduction of BB Bisoprolol.
I also raised my B12 level to 700.
Finally I now accept where I am but a H/R of 60s Day better for me.
Accepting where you are is a great plan. I would never commit to irreversible surgery unless it was a life and death situation and I'm still not sure about that! My AF is fairly well controlled with beta blockers. They have the advantage of not inflicting anything too permenant.
Five ablations, multiple cardioversions, the entire pharmacopoeia it seems, and STILL in arrhythmia.
Go for yet another ablation or try sotalol was offered. No more physical damages to my heart, please. Let’s try sotalol.
Honestly if medication controls the Afib I would not have the ablation. The problem with Afib is there is no cure none. So it's a matter of reducing incidents to a minimum.Every episode of Afib causes further damage to heart tissue
The danger of course with long term if worsening because the electrical channels that the impulses follow become learned and thus changes to electrical patterns have to great possibilities of becoming then permanent.
In my case I am very limited as to drugs because I have Afib and mobitz also.
It's a choice for what is best and age definitely plays into that.
None of my doctors not any of my 3 cardiologist nor my primary care believes in procedures as a first resort. However it is individual on a case by case basis.
I'm waiting now to see if I need a valve replaced before moving forward.
Please change your thinking to CONTROL of H/R and CONTROL of BP.
If medication controls the above forget the AF and its irregularity. Reducing H/R under 100 Rest and BP at 120/80 your AF will slow.
Why need the antiarythmic risky drugs?
Relax and see about your heart valve. My friend has had 2 replacement valves. The first was a pig's! At 12 years it has become infected but they can't remove it fully. She has a manmade one alongside it. Antibiotics daily. Alive at 83 with debilitating MS.
I am only 4 weeks in after a PVI ablation and having AF episodes, so I’ll reserve judgment on its success. However, I would urge anyone with AF to read The AFIB CURE by John T Day & T. Jared Bunch which I found very interesting and informative concerning the position of ablation in the strive for improvement in our QOL.
It’s no cure true. But it can lessen symptoms. Iv had 3 ablations and my quality of life is much better now including my mental health.! I tried the drugs, the lifestyle changes etc, but it was slowly getting worse over time.!!!
My mental health was starting to suffer too.? I was becoming a nervous, frightened wreck who dare not go to sleep for fear of not waking up.? I think if you’ve tried everything else and it’s not working then ablation has to be talked about and decided upon for very symptomatic people anyway.( like me) But if you don’t have symptoms and you’re heart rate is controlled by meds then that’s good too. Decisions decisions.???
OK I seem to have opened a can of worms here. I apologize! I was talking about groups I have belonged to, where they insisted the only option for Afib is an ablation. I do not want to name names, but there is a woman in the US who runs an Afib group. She argued with me over and over that I needed to have an ablation if I were to ever be Afib free. Yet I have remained mostly free of episodes for over twelve years! I do take Flecainide 50mg daily on the advice of my GP. My Cardiologist had told me to do PIP instead. However I had a few small outbreaks after not taking it for five months. So my GP suggested I go back to taking it at a lower dose daily. So far so good.
This is where I am. The problem as I see it, is that there's no consensus as to what is causing or triggering AF in the first place. For me, it seemed to be Graves disease, it went away after radio iodine and then came back with a vengeance. Though persistent AF, I'm lucky enough to be relatively symptom free but it's at the back of my mind whether it'll get worse the older I get. I wholly regret having the radioiodine because while it had reversed my hyperactive thyroid, it has also now destroyed it, putting me underactive, there's no coming back from that once the procedure is done.
I suppose another way of looking at it is whether over time the AF causes the atria to dilate; I don't know the long-term prognosis from that, but I suppose it's a balance between some damage from scarring to rectify the AF, or the potential remodelling of the heart by leaving it. Ablation or any procedure, is a difficult decision that should be made in consultation with a Cardiologist.
Since last October I had raging AF 40-50% of each week. I have a healthy heart and normal BP. None of the drugs worked and I suffered miserable side-effects whilst trying them all out. Pulmonary vein ablation was the only way forward and I had it done two months ago. All gone well and I’ve had NO af since. It’s transformed my life!
NB I’m slim, fit and taking loads of supplements - nothing helped.
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