Hi, I have had one, or maybe two episodes of afib with rvr following vomiting, 10 years apart. The last episode lasted for two days until it was reset with beta blockers. I am otherwise a fit, healthy active 56 year old. The EP suggested I have an ablation, what are your thoughts? Also, can anyone recommend the best EP doctors in the Houston area?
Thank you
Similar history to yours and also from the States. My first afib episode was around forty and then I had another three episodes also ten years apart. My trigger then was cold drinks. So with only one episode every ten years, for close to 40 years afib was a non factor in my life. I didn't take any meds for it and didn't see an ep, except when I was cardioverted in the hospital. I finally got an ablation in my mid 70's when the frequency of my episodes increased.
If I had to do it all over again, probably would have ablated in my 60's for the sole reason I would have been younger and stronger to handle the ablation procedure itself, especially the anathesia which in the US is usually general (GA). . If I was in your position -- 56 and in good health -- and assuming things don't get worse -- I'd probably have a ablation within the next 5-10 years, but certainly no rush. Hopefully, by then there will be some advances in the technology as for example, PFA (pulse field ablation).
Your ep is not wrong to suggest an ablation now, but that's what ep's do. "To a man with a hammer, everything looks like a nail". So to an ep, every afib patient looks like an ablation candidate. At least in the US. From what I read here, in the UK and Europe, less of a rush to ablation.
Jim
I though I replied to you but didn't see it posted, but if it didn't post, that is really helpful, thank you!!
Note that Medtronic has a new technology just approved in the EU, and being reviewed by the FDA for a new Ablation technique that reduces the risk of traditional thermal ablation by using energy bursts. Certainly not an expert on this…but for those interested, worth reading up on it.
As has been suggested, the situation regarding when to ablate tends to be different here in the UK than it is in the US. That said, it is generally accepted by UK heart specialists that ablations tend to be more successful, the quicker they carried out after diagnosis. However, the reality is different, largely because of the difference in the way treatment is delivered here compared with the US. I’ll only explains what happens here because, (a) - I don’t know the details of what happens in the US and (b) - You will!
Here we we have the NHS which effectively provides all the medical services to the majority of the population and it’s funded by obligatory contributions made by everyone during their period of employment which generally means there is a degree of prioritisation based on a variety of different criteria. Whilst many AF patients might understandably disagree, controlled AF is not seen as priority and this is a shortened version of why many here go through what often is seen a long and protracted process to get an ablation if that is what ultimately agreed is the right route to take. However, we also have a private health sector which is available to those who can afford it but it is minuscule compared with what happens in the US.
The point is that if anyone here is fortunate enough to have access to private health, they are likely to be offered an ablation more quickly and although there are commercial considerations, all things being equal, there are benefits in having it done sooner rather than later. There are a raft of things the patient needs to consider, not least your AF burden. Over here, if you see an EP privately for a consultation and they are prepared to accept you for their NHS list which could mean a 12 month wait, at least you can be reasonably sure you are doing the right thing.
Many here will point out all the things you need to consider in making your decision but I think most will agree that if an ablation is decided to be the best route to take, the sooner it’s done, the better. Good luck with your research….
Hi, thank you for your reply, I am actually English, been stateside for 24 years, so I fully understand NHS, BUPA etc and the US system, but my sister who lives in England and has had SVT for 10 years has never even heard of an EP!! And she has private health insurance!! I tend to agree with the fact that they are finding new, less invasive procedures but on the other hand I don't want to be traveling to a remote destination and then find I have AFIB. Hmmm!
Being in Houston, I would certainly consult with Randall Wolf.
i will definitely check him out, thank you!
Randall Wolf is not an ep, but a cardio thoracic surgeon who performs the mini maze procedure. You may or may not be interested in this procedure, but it's an altogether different animal from a catheter ablation.
Jim
I gathered that and i don’t want that but he does see people for a second opinion and responded to me himself yesterday and said he would see me i n person. Maybe he could insert a hr monitor. I will also try to see the EP in Austin, Dr.Natale Thanks for the heads up. I do believe a mini maze would be extreme for my condition but on the other hand my EP did say the fact I had a sustained HR of around 180 for two days is a serious afib. Just trying to gather as much info as possible before I let anyone near my heart!!
Yes, Natale is either the best ep in the country, or he does way too much burning, depending on who you talk to. What he offers is PVI plus, plus, plus -- not just a PVI. I eliminated both Natale and Wolf from my list for my first afib ablation because I felt their aggressive treatment wasn't warranted. However, they are both on my short list should my ablation fail. Definitely listen to what they say, but understand that both are outliers in the afib treatment community. For bettter or worse.
Jim
That is very useful information-thank you!
Jim has nailed it!
UK. I have had two episodes 2 and a half years apart. The first one caused by a prescribed non steroidal painkiller . The second , I assumed all was ok and ate loads of sugar over Christmas topped off with a Chinese meal on New Year’s Eve. Spent New Year’s Day in hospital . Both episodes lasted 24 hours heart rate 170+ no cv .
I was offered an ablation . Because they are not risk free, not always successful , I don’t do well with drugs , I said I would be good regarding triggers and see how I get on . My one year anniversary of that AF episode and being sugar, Chinese food and several other things free is coming up. I am 68.
It’s a personal choice . As Jim said, surgeons love to operate but they walk away from the consequences as do prescribers it’s the patient who lives with the consequences good or bad . I worry about travel , remote destinations etc but anything can happen to anyone at anytime, when previously healthy and then you have an AF episode it heightens awareness of vulnerability. It’s the tipping point where you feel the benefits of having an an ablation outweigh the risks . I am not there yet . Only you can decide
It sounds potentially excessive to me and brought to mind that the US health care system lends itself to over-medication and treatment but the reply from Jim seems to nail it, to use and extend his metaphor.
One thought I had was that retching while vomiting pulls dramatically at the diaphragm and, thus, indirectly, at the heart muscle and this is known to bring on ectopic beats in some and those to trigger AF in the prone. This does suggest that your heart cells - likely those around the pulmonary veins - are already prone to misfiring, something that might well get worse as older age creeps on, so an ablation might help. But still, it sounds extreme to me.
Steve
Thank you, yes the EP seems to think this will progress, especially as I had my last episode with RVR lasting for two days and only converted with meds in the hospital...
Hi Iamfuzzyduck,
I do totally understand your dilemma. I have had PAF for about 18 years, many of those undiagnosed…and my episodes were very infrequent, initially every five years or so, then perhaps every other year, until I was diagnosed in 2021, when it all changed and I got them monthly which I know was due to the anxiety of the diagnosis.
I take 1.25 mg Bisoprolol daily which helps and my episodes went to yearly again. I was told I wasn’t bad enough for an ablation in early ‘22, when I enquired.
Something appears to have changed in the NHS regarding afib this past year it seems (we may be adopting the US way of thinking perhaps?) as I had a totally different opinion from a different EP, who offered me an ablation and I’ve accepted. For me, I’m taking the risk, as I struggle with the anxiety, worry and the uncertainties that afib brings into my life and the constant ‘tip-toeing’ around it. If this is a chance of a normal life, then I’m going to take it, even though my episodes are infrequent.
I was holding out for a pulsed field at some point, but then found out from an EP that it only tackles Afib. I have Afutter and Tachcardia too during an episode, so that’s off the cards for me. So, I’m striking while the iron is hot! I’m 57 and have no comorbidities.
Only you can decide what is best for you. Good luck.
Good luck with your procedure! Maybe I will wait for the pulsed field procedure!
It might be worth it, as it’s much more available in the US than the UK. You might not get another ‘episode’ for another ten years 😊
That does seem rather an overly enthusiastic response to me - ablation after two episodes 10 years apart? But what do I know....
I would second MiniMeGreen 's response though and suggest you check out Dr Randolph Wolf as you're lucky enough to be in Houston.
I certainly will try to have an appointment with Dr. Wolf, thank you!
Lucky you! Do report back, there's many of us on here very interested in the Mini Maze procedure.
The American College of Cardiolgy posted Nov 30 2023 new guidelines regarding diagnosis and treatment of A fib : jacc.org/
That is really useful, it seems to suggest I am a prime candidate for the ablation, but I a may hold out for the pulsed field...
That link only took me to their 'landing page'. What was the name of the specific article you're referring to?
You have to scroll to guidelines, then open the one for afib
Atrial Fibrillation Guideline Hub2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Chairs: Jose A. Joglar, Chair; Mina K. Chung, Vice Chair
November 2023
DOI: 10.1016/j.jacc.2023.08.017
World renown EP Dr. Andre Natale is in Austin TX. Dr Randall Wolf in Houston is a world renown Cardiovascular Thoracic Surgeon who is the pioneer of the Wolf Mini Maze. Texas is certainly the place for some of the best treatment one can receive for afib. Ablation-Dr Andre Natale, EP, Austin . Mini Maze-Dr. Randall Wolf, Surgeon, Houston.
Warm Regards,
Kat
Thank you for the info, I shall certainly look into both of these doctors as both are easy driving distance
If I were you, I would think carefully before consulting Dr Wolf.
Bearing in mind that currently, your AF burden is low and episodes are few and far between, even Dr Wolf’s fervent admirers acknowledge that his procedure is designed to treat people in persistent AF who may have already experienced a number of catheter ablations which have failed. I’m not questioning his ability to treat folk in that situation or his ability to help them but he has produced videos saying ablations do not work and a couple of years ago they were posted on this forum. It seems that there are different tactics used in the US to promote treatments than we are used to here in the UK so it’s difficult to know if you would get an unbiased opinion.
However, I’m sure that you are more than capable deciding the best course of action after considering the advice provided from whatever source. Good luck
I agree, it is difficult to know if the doctors are a bit eager to push treatment here! I am not sure if I do have some ongoing afib as my apple watch notified me that last week I was in afib 4% of the time, which really annoyed me! I am on a waitlist for Dr.Natale for his March schedule, so I expect I will end up with him. Dr. Wolf gives second opinions and there are EPs in his group at Houston Methodist...
Two episodes of PAF in 10 years, and a doctor suggested an ablation-in other words shove a catheter up your groin, into the right atria, poke a hole in the septa, and then monkey around in the left atria to "remodel" neural pathways with scarring. Then a long and possibly eventful "blanking"/recovery period lasting up to possibly 6 months.........and then possibly the opportunity to do the same thing all over in a "touch up" procedure.
If I were in your shoes, I'd get a second opinion-from a cardiologist, not an EP. Just sayin'.
JimF
Yes, I think I need another opinion! The EP I saw though was trained in Europe, he's only been here two years..
Take a look at posts on here from people who've had multiple ablations and it will give you some insight into your decision. If it was normally one and done, it would be one thing; but people having to have 3 or 4 or even more isn't a ringing endorsement to me. I'm female, 79 with several years in persistent afib (the best kind to have in my opinion), asymptomatic and resting heart rate 70-80, so it's not something I would consider unless there was a drastic change in my condition.
P.S. Since you're in Texas, you should definitely check in with Dr. Wolfe.
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