Hi , would like some advice please , have been waiting 4 years to see EP on NHS have seen him privately over a year ago but got a phone call today to say I am nearly top of the list for an ablation . My dilemma is that I have not had an episode of AF for 14 months . I am taking flecanide 50 mgs BD and nebivolol 2.5 mgs daily . I am a bit anxious re surgery and am concerned that it may make AF worse .Do you think I should cancel ?
Ablation: Hi , would like some advice... - Atrial Fibrillati...
Ablation
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oliviab9
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BobDVolunteer
Would you not rather be off a nasty old drug? Only you can choose but of course you will need anticoagulation as well for a period before and after at least.
I've had three ablations and still have AF, but now at a lower rate between 60-90 and I can lead a fairly normal life.
I wonder if your heart would be ok if you didn't take your Flecainide now? For me that would be the deciding factor I'd need to know. If your AF came back without it then yes go ahead with the ablation (that may or may not work).
Jean
Thanks for that . I was thinking same thing . I think I need to have a consultation with EP rather than just start taking anticoagulant prior to procedure which was his secretaries voicemail today would like to leave it until new year but don’t think I will have that option .
I can understand you thinking that. There is no race to have the ablation, but as Bob has said do you want to continue taking medication for a long time? Have you tried not eating foods that contain artificial additives? Artificial sweeteners were a sure trigger for my AF.
Jean
Hi have been doing that and not eating after 7 pm no caffeine trying to keep hydrated I feel that that has helped . Feel Bob is right prob time to try and get off medication .
I was told to stop my Sotalol for 2 days before my Ablation last Wednesday and at 2.30 am, my AFib started, so I went to A&E. I have to go there, Drs orders, as my AFib makes my Blood Pressure and heart rate soar to high levels and I was then taken to the hospital where I was having my ablation. The Drs said it was because I’d had to stop them suddenly, for the procedure. The dose of Sotalol I take is high. If I’m told I don’t need medication anymore, I would stop them very very gradually.I believe most people can stop their heart medication, if the ablation is successful, although I believe most people have to stay on anticoagulants.
tough question to answer. Personally I’d go for the ablation. A high chance of success seeing as your only PAF. had my 2nd ablation 4 weeks ago.
Thanks are you making a good recovery ?
Hi. Yeah. Fingers crossed. 4 weeks in and feel great. So much better than after my 1st one.
They do say you recover better after the 2nd.
I’ve took it really easy last few weeks. Tried not to get my heart rate above 100 bpm
Glad you're doing well. I was wondering how you were getting on.
Yes I’m good thanks. How are you ? 4 weeks since ablation and I feel fine. Wondering when to stop the apixaban ?
I wouldn't have thought they'd want you off it until the blanking period is done.I'm still ok, thanks. I've been very fortunate that despite waiting for the valve repair, I'm going about as if nothing is wrong. I know there may come a point when that changes so I'm hoping the heart behaves in the meantime.
Here's to your continued recovery. 😊.
Same to you. Hope it goes well. I’ll carry on the diltaizem for a while as well I think.
I'm surprised they've not given you some sort of plan. Maybe give the arrhythmia nurses a ring.
Hi I spoke too soon. I’ve had 4 af episodes in the last 2 weeks. I was really happy upto 5 weeks after the ablation was fine then 4 attacks between week 5 and 7 week. Damm
4 years! Northern Ireland??
Don’t cancel! you will have a pre op appointment talk to them - not us!! Your AF is held in check by medication. You will maybe have to take that forever? The meds have downsides. The ablation of your heart is suitable should have a good success rate in stopping or minimising AF. Talk to the clinicians. I don’t regret mine!
Yes am in Northern Ireland under Dr McCann it is strange that I got a call because I had a generic letter recently asking me if I still wanted to be under review by them ? But had seen him privately in 2 occasions last time being a year ago . Did you have yours in NI ?
No but know the waiting lists are terrible in NI! South of England - waited about 8 weeks for ablation in 2020 current waiting time at my hospital is 4-6 months for.a non urgent ablation. Good luck!
Eventually the meds often stop being effective. I put my ablation on hold twice,then went downhill rapidly and couldn't wait for it to be done fast enough!Who knows what the future may bring for the NHS? Ablation may be seen as elective,non lifecsavingvand cut from services....?
Yes think I would be delaying the inevitable ,agree services are being cut to the bone . Thanks for your advice
I wonder whether drugs lose their effect any more than the rogue signals find new ways around the ablation scars? I have always supposed that it might depend upon what the root cause of the problem is, and that seems rarely to be uncovered. It's certainly hard to find useful and concrete information. My son has an older friend, now 76, who has had, I think, six ablation procedures over many years and can't have any more but whose AF has now returned along with flutter. He's managing well on drugs, however and seems fine.
Steve
I recommend this lengthy uTube about AF and its causes and about ablations. Excellent
m.youtube.com/watch?v=dNPpz...
The link fails to open the video, sadly. Is there a title or search phrase I could use that would bring it up, maybe?
Regarding the root causes of AF, I would be interested as I doubt this is often found or perhaps even yet fully understood medically. I would guess genetics plays a crucial role, for example, and then, with that individual background, whatever life brings our way (or we throw at it) adds to the genes and bio, AF results (e.g. over-drinking, obesity, hypertension, smoking, extreme physical activity... a long list).
Steve
I managed to find it. Thank you and it's a video that is well worth viewing, although, as you say, perhaps it is somewhat over-long for what information is actually conveyed. That is the nature of YouTube videos these days more than ever.
I have seen it before, in fact, along with several other of Dr Gupta's generally very worthwhile videos. I felt that he was being a little disingenuous at times on this one since, as his other videos show, he knows a very great deal more than was implied about arrhythmia issues - but of course this video was aimed at a particular kind of audience and geared to that.
More importantly regarding what I was trying to say in my post above, the root causes of AF and arrhythmias were not properly discussed. Both doctors did give some "causes" such as high blood pressure, alcohol, OSA and diabetes, and others; but, like AF itself, however, these illnesses are themselves the product of something else going wrong, i.e. the root cause is still often ill understood. To say that hypertension causes AF, for example, is less than helpful in the sense that patients who have their high BP controlled do not seem to get less AF (this is from memory, so I hope I have got that right). The same applies to other "predisposing" conditions. The inflammatory processes (and likely the genetic predisposition) that are rarer to the root causes are areas that medicine is still trying to understand and uncover. Only then will treatment be more than a kind of "sticking plaster", as it were, and - with luck - become a genuine cure.
Steve
I think I heard that the body’s pacemaker cells as formed in the embryo can be misplaced, ie in the pulmonary veins or even dotted around in the heart. The misfiring from them can be triggered by many things including rapid changes of heart rate from intense excercise, many areas of ill health stress the heart, as does alcohol and stress.
That’s right but most people never get AF and many do those things. I wish we knew more about the root cause so that we might be able to address it in time.
Steve
Not everyone will have embryonic pacemaker cells in places that lead to miss firing
You’ve sent me off reading a few studies on this. It’s very interesting. Thank you! The more scientists look into the heart, the more they find that they need to look more closely.
Steve
Do share the articles!
I just searched "embryonic pacemaker cells" and read the summaries of a few of what turned up. Many are rather old and many more far too heavily scientific but I had previously read that all cardiac cells still possess PM properties hence the production of ectopic beats, for example (PACs and PVCs). Your comments and some papers suggested this might not be the case.
If I find anything recent, I'll send the link, but this is an early one that was interesting:
ahajournals.org/doi/full/10....
Steve
Yes I think u are right that drugs do loose effectiveness and can be toxic over a period of time , so little research out there and lots of differing reactions to ablation itself and medication .
my AF went from occasional episodes managed by Flecainide as a PIP, but when I became poorly for other reasons my AF went from bad to worse. It became persistent when I caught Covid. I was desperate for the ablation when it was done in June 2022.
It has provided a much better QOL.
Of course it is your choice but AF is often progressive, ie it gets worse over time, so my advice is to do it now.
I doubt an ablation will make your AF worse, but equally there’s something like a 30-40% chance that it won’t fully prevent future episodes. Also, unless you’re under general anaesthetic for the procedure, it’s not always an easy experience, although we all differ on that (mine was under a GA and was far easier than I ever imagined).
It’s not an easy decision and the general feeling is to go for the ablation these days. But that doesn’t necessarily make it the right choice as the evidence really isn’t fully clear.
Overall, the likelihood is that AF will eventually return and, over time, even become permanent. When that happens, it seems it’s actually far easier to cope with for many sufferers and seems to do no great harm. It all depends upon the level and kind of symptoms the AF causes as well as the overall state of your heart and other health factors. This means that each case is unique and only a doctor can advise. My elderly friend, now 90, has had permanent AF for many years and is near symptomless.
Steve
Hi. I don't know your age but I'm 69 and have had paroxysmal AF for about 10 years. Following diagnosis, the episodes were coming about 9 months to a year apart. I was offered ablation then but felt it sounded awful and that I could cope without. However, they gradually became more frequent as I was told they would. Eventually, 2 years ago they were coming every week so during a telephone appointment with the cardiologist in December 2021, I asked to go on the waiting list and eventually had my ablation this August. I was sent full information on the procedure and was given ample opportunity to ask questions which I did and was told I could come off the list if I changed my mind. However, as the condition is progressive and was only going to get worse with time and age, I decided to go for it. It was scary but it was nowhere near as bad as I had envisioned. I am now nearly 7 weeks post ablation and apart from an episode the day after the procedure (which I felt was due with all the usual triggers), I have been AF free so far. Only you can make the decision, but my view was I will only get older and therefore my health would be worse so I may as well go for it while still feeling relatively fit. So far no regrets. Good luck
Glad to hear you are doing well . Thanks for reply I am 58 and have had PAF for 5 years I think I am just a bit anxious about surgery and keep trying to tell myself how bad I feel when I’m AF x
I would go for the ablation. If you don't then Murphy's law will strike and the AF will come back and then how long would you wait.
I went through a bad period and decided to go private as waiting list too long for my liking. I then went a couple of months while waiting for ablation without any episodes but still went ahead with it and EP said I needed lots doing and would definitely had got more episodes sooner than later had I not.
Having just had an ablation and open heart surgery to replace Aortic valve and repair to Mitral valve my opinion would be do not have the ablation yet. Mine did not work and even if it had it only works short term. Obviously it has to be your decision and evrryone is different.
How are you doing after the ohs? I'm on the list for a mitral valve repair, caused by my AF. They're going to do a Cox Maze IV at the same time to tackle the AF so I'm hoping it doesn't cause Flutter.How was your general recovery after the op, if you don't mind me asking?
Hi,My operation left me with AF and flutter.... The recovery was ok but painful as I refused the analgesics. The operation or more accurately intensive care afterwards was grim. Never again. Ablation was ok but much more trauma to the heart than I expected and does appear to have failed as I am still in Af. Time may sort it?
Good luck with your procedure and make certain you are well hydrated at all times
Thanks. Grim intensive care doesn't sound great so I'm hoping you aren't in Coventry 😳. I've already had an ablation 2.5 years ago, which didn't work. They think the valve issue contributed to it being unsuccessful.Hope that things improve for you and thanks for replying.
Normally you have a pacemaker fitted th en the ablation 3months later,this sorted the af.
Hi there oliviab9 . Having an ablation was the best decision that I ever took!! Flecainide was wreaking havoc on my QOL! I am now off all heart meds and only take Eliquis. I have so much energy and sleep so much better. And the EP pointed out that it is better to havecan ablation while you are still in paroxsmyal a fib rather than permanent a fib. Also, for me, the procedure was not difficult at all and was carried out using general anesthesia in August 2022. Best of luck to you !😊
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