The cardiologist I see is not able to provide medical management of my paroxysmal afib due to my low heart rate and low blood pressure (can't risk pushing either value lower), so I am hoping for an ablation. This morning, due to a cancellation, I was able to bring my initial EP consult forward by 1 month, so it is now just 2 days away. I already know the EP is one of the best in my area and works at the hospital center that handles the largest volume of ablations in my area. I am wondering what questions I should be asking?
What testing do EPs do to determine whether you are a candidate for ablation?
I see benefits of having an ablation asap, but what might be the benefits of waiting? Does anyone think that light therapy (or some other non-detructive/non-scarring intervention) might become a treatment for atrial fibrillation in the near future?
If, I am able to schedule an ablation, realistically, how quickly afterwards might I be able to return to thinks I take for granted, such as: riding my bike up and down hills, helping my 90 lb dog (who was diagnosed with afib, cardiomyopathy, and heart failure in Nov 2023/!talk about stress!) up and down a flight of stairs by lifting with a special harness (required several times per day), carrying groceries up a flight of stairs, 12 hour flights to visit family, etc?
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Desertflowerchild
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Thanks for your input. I am hoping ablation (without pacemaker) will be my answer for now. But that is indeed something I will want to discuss with the EP.
I can't say enough good about my cardioäblation... to be honest, my cardioäblation went so smoothly I have a hard time remembering my recovery. Only testing I remember was ECG though the EP did a transesophogeal ultrasound immediately before he started the procedure.
I took things very easy immediately afterward but felt 95% better overall. I was really scared about the healing of my femoral artery incision after my stent emplacement during my heart attack... afraid I'd accidentally rupture the incision. Even though I had absolutely no problems, it's just how bad things can go that worries me. That said, no problems after my cardioäblation femoral incision either.
I did feel tired the couple of days after my ablation, but started light walking the next day and probably within a month I was walking my daily 5 mi/8 km.
Overall, I reclaimed my very active lifestyle... I posted yesterday a posting about how I've worked in a mountain camp in southern California for the past two summers and am presently 15-25 yd³/m³ of snow a day for the past two days.
In the interest of full disclosure, I've been lucky that I've responded so well, but I've also made some of that luck in that I'm really serious about using Esselstyn/Ornishesque nutrition and lifestyle to support my CV system as well as ProLon fasting mimicking dieting.
These questions are all so very much dependent upon your individual condition that only a doctor can answer. The alternative to drug therapy is an ablation and they have a success rate of 60% or so over time, I gather. Both treatments are still considered symptom-relief rather than curative, so remain a choice rather than an imperative.
I wish I could be more helpful, but feel that no general answer would be useful.
Thank you. Yes, I wish there was a clearer idea of why afib starts. It does seem to run in my mother's side of the family. My mother is 93. She and several of her brothers were all diagnosed with afib.
That's fascinating. I had a mother who was never diagnosed as having AF but who did frequently referred to her disconcerting feelings of flutters in her chest. Sadly she never reached the grand age of your own mother. I hope she is well and is treasured for her longevity.
Her "flutters" were what I had quite often until 2019 when atrial flutter began in earnest. Previous to that, neither AFl nor AF had ever been diagnosed but I had had a few strange "panic attacks" over the years, put down to anxiety. The cardiologist I saw for my AFl quite surprised me by saying that there was a high chance those were arrhythmia episodes and not anxiety. That makes such sense to me now.
In terms of genetics, I think there is some evidence on this but it might be more than genes alone and be a combination of environment and genes. That makes sense to me. One thing that I was never aware of was that the heart cells are unique in the body and can never be replaced or repaired. This means that once they go into AF, they always will have that weakness and the right provocation will start off AF again.
Heart cells repair. The issue is whether the repair keeps up with damage. Search "autophagy and heart" or "cardiac autophagy" or "stem cells heart". My personal experience: For almost 30 years I had a pronounced heart murmur and a diagnosis of mitral valve prolapse (diagnosed in France, again in Australia, and in the USA) which is supposedly progressive. At this point, nobody can hear a murmur and my latest echography showed little to no issue with the mitral valve.
That’s interesting. I look forward to reading that - I’m sure you’re correct. My understanding was that cardiac myocytes can never be replaced but are very “tough” and able to revert to normal when the stresses on them are removed. That is up to a point, though.
Reading about this I can’t find evidence for what you say. Can you give me a better search term, maybe? I would have been thrilled to find I was wrong on this and look forward to reading more.
So far as I understand it, cardiomyocytes can return from even a severely stressed state and autophagy might help to protect them and enable this to happen. Stem cells seem only to be important in neonatal hearts (as expected) and, from what I could find out, play very little part in mature hearts (although I found some recent experimental evidence that points to there being some role but likely minor).
I’ve just seen your second post. Yes - I think that’s right. I read one theory that even suggested that autophages might yet be shown to work to aid cell death.
I’m not sure whether AF cells can repair themselves and it seems it’s not known. I did read that stretched cells, for example in enlargement through obesity, do become arrhythmogenic and that this reverts to normal when the stretching is removed.
Isn’t it simply wonderful to read work of such scientific frontiersman-ship?
Utterly marvellous as this is, of course, this is still grafting, i.e. transplantation, rather than auto-regeneration. The necrotic cells and scar tissue will remain in place, unregenerated and unregenerative.
"In a study published last February in The Lancet, researchers treated 17 heart attack patients with an infusion of stem cells taken from their own hearts. A year after the procedure, the amount of scar tissue had shrunk by about 50%." Perhaps a little more complicated than a graft? Or is that the correct term for this? I wouldn't know actually.
Well, that is different from the first trial, and, yes, something amazing seems to have happened there. That trial showed promise and yet little has been shown in the meantime. In fact, the appearance of regeneration seems not to have been borne out, either.
If you search for the 2023 paper "The sad plight of cell therapy for heart failure: causes and consequences" by Roberto Bolli and Xian-Liang Tang, you'll find an excellent reprise of the current state of affairs.
Thanks for looking for these studies and setting me off reading. Such work fascinates me. Whether this might eventually help AF, who knows? We can but hope.
I was once a scientist, a whole lifetime ago, and, at that time, I would have never imagined scientists falsifying data. I have been shocked by the revelations in more recent years and now never know what to trust. I noticed also that the expected sequel to such amazing results had not seemed to materialize over the years. Thanks for the paper citations. I will look at it as soon as I have a moment.
I would have been scientist if my maths skills had allowed me but they let me down and that affected my chemistry and physics, of course, since those subjects, essentially, become maths in advanced study. Instead, I went on to become a marketing manager in the pharmaceutical industry, and then an English teacher, but now largely retired.
I still have faith in science and the scientific method. Journals, the profit motive, the need for having work published and much more put pressure on individuals and some will cheat. It's tragic, really. When you read the paper on stem cells, you will feel saddened that this promising work is virtually in limbo. I did find that, given the money, it's possible to have the treatment done privately at a cost of about £12,000.
I was going to have another ablation for my afib (left side one this time as first one right side Aflutter), but in the end because of my low heart rate and low diastolic rate it was decided on a pacemaker. Such an easy procedure and now a steady 60bpm and it seems only a little bit of afib occasionally but I’m completely unaware of it
I can see the members have already offered their advice and support regarding the ablation procedure. Remember, everyone responds differently to procedures which can also affect the recovery basis on an individual basis. You should speak to the Consultant for advice nearer the time.
Have you visited the AF Association website where by you will find much more information relating to AF and treatment options: heartrhythmalliance.org/afa...
Hi, the new guidelines in the US have ablation as frontline treatment for paroxysmal afib assuming you don’t have other complications. I have been told by my EPs (x2) that in my case it will be 90% effective as is early on and should be straightforward I don’t take meds as i have a low heart rate due to me being active. They also say i can resume activities 5-7 days after (ie going back to CrossFit). You will need blood thinners two to three weeks before the procedure and 2-3 months after assuming you don’t have any other risk factors for a stroke. I am going to have the new pulsed field ablation with Dr.Natale- there are a few hospitals in the US that do it. It takes less time and there are fewer risks of complications with it. However not many drs are comfortable doing that procedure yet. I hope this helps…
Sounds great! At one time, I was going to try to wait for the pulsed field ablation to become more generally available. I actually have no idea whether it is now available at the hospital where I will be going. Best of luck!
There is a list of 30 plus hospitals in the US that do PFA. Dr Natale has been doing this procedure for more than two years as he was involved in the trials, I believe.
Tbh the list is on the AHA forum and I don’t know if that is for trials only or if it is open to the public on those hospitals. The hospital go will go to is open to the public
IAmFuzzyDuck wrote a good post... in my initial reply to you, I was having difficulty recalling the run up to the procedure. IAFD's experience was similar to mine.
Hi, Have you been offered a cardioversion, less invasive than an ablation and may last just as long in controlling your AF. Ablation not usually a permanent fix just another step on the AF journey. I've had 3 of each, cardioversions kept me AF free for over 12 mths each time. If you have ablation you would not be able to do some of your strenuous stuff for a while. Cardioversion recovery usually quicker.
So far my episodes last between 6-24 hours and I self convert. Isn't cardioversion to convert someone from afib to normal sinus rhythym who doesn't self convert? In any case, that is great that a cardioversion keeps you afib free for so long each time!
wow. First of all if you can get the ablation, please do it and you should not be doing any of that stuff even now without the ablation. I have a 12 year-old 80 pound dog with very weak back legs so I know what you’re talking about there. When it comes to your heart all I can say is the American heart association after I actually was diagnosed with a fib had come out with a campaign on TV and more the title is NO TIME TO WAIT. I hope that tells you something. I am the opposite for me. It’s tachycardia since day one.
There is no guarantee with your ablation but it’s a good shot right now as far as everything you listed, you need to stop take a breath, and get help You are gonna have to think outside the box to help your dog and yourself whether it’s a cart for groceries or pee pads for your dog you can’t be lifting him. I did it once helping my boy onto the bed immediately I knew I should not have done that.
This is not a race you are in
The longer your heart rate is bad the more danger your heart is in. Because of the length of time of tachycardia for me, I developed heart failure. Let me tell you now, and within a short period of time after I got my pacemaker, my heart failure began improving that is because my heart got a chance to rest and be doing what it should’ve been doing. Right now you have wear and tear constantly on your heart and I can’t continue something has to give.
I can’t say I understand why your doctor still can’t treat you, but I don’t quite understand your medical there Please get any help you can immediately. ❤️
Thank you for your concern. Yes, if you have a 12 year old 80 lb dog with weak back legs, you know what I am talking about.
My situation is not dire: My paroxysmal afib burden is probably less than 3% per year and most of my episodes only involve a heart rate of around 90 bpm, if I take it easy. I often don't have any episodes during June, July, August, and September when I am pushing myself fairly hard with my road bike. I am a great believer in the positive benefits of exercise. I would expect my afib would have progressed more quickly if I was less physically active
Why I can't be medicated: Most medications for afib, whether thought of as rate or rhythm medications , will depress the heart rate. Because my normal unmedicated heart rate tends to drop quite low (into the 40s every night), it is risky to use a medication which might reduce the heart rate even further. My cardiologist and the EP both agree about this.
I got to meet the EP yesterday and I like her very much. I will be scheduling an ablation in late April. She would prefer for me to have a pacemaker inserted at the same time so that medication would be posible for me in the future (and during the healing period). However, she allowed me to make the decision and I am not ready for this step, while I do understand it may become necessary in the future.
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