I have had three episodes of af over the past 15 years. Two caused by alcohol over indulgence and one I don’t know the cause. Two were within three weeks of each other. I have been recommended to have an ablation as it could potentially stop it in its tracks for a few years. What do you all think. 🤔 should I have this done. Have you been successful after your ablation ?
will ablation stop my paroxysmal af - Atrial Fibrillati...
will ablation stop my paroxysmal af
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Nantoone
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Having just read your recent post on BHF forum, your history is not quite as simple as this post suggests. You've already had one ablation it seems. I would go with your cardiologists advice and go for an ablation. Also, most importantly give alcohol a complete miss! It is a well known big trigger for AF.
Best wishes
J
Well you know one of your triggers is alcohol so give that a wide berth. Other possible triggers are caffeine - though not for me as I have drunk caffeine free coffee and tea due to overactive bladder problems for years before being diagnosed with AF but I know some people who find this so. One person I met at my cardio clinic was amazed that he always had Af on a Friday and realised eventually that this was because he sent out for a large capuccino on Friday morning break time and when he stopped this he didn't get Af that Friday. Another there found that it was just white wine that was one of his triggers but could drink red wine or spirits and beer! It doesn't make sense does it? It seems that is the nature of AF.
If your consultant is advising you to go forward with another ablation then I would go for it. In the meantime get your self as fit and healthy as possible - lose weight if you need to, eat healthily and exercise so that you are as healthy as possible for your ablation and can make the most of it. Take it easy afterwards and do all you are told to make sure this works as well as possible.
Hi Nantoone
I’m wondering whether the success of a second ablation in your situation depends on the likelihood of you being able to give up alcohol. It does seem to be a clear trigger when you have too much.
Hi Nantoone
Unfortunately, ablations don't come with a guarantee of afib eradication.
My understanding is that the ablations aims to eradicate the potential heart driven "triggers".
The ablation process will not stop you continuing with your own triggers such as alcohol.
The good news is that you have already identified one of the triggers which is within your ability to eradicate. I know that it's hard, as alcohol was a trigger for my PAF as well, so I have had to give up as well.
That makes zero sense. There is no difference between heart driven triggers and your own, they are the same. And if you successfully ablate the main trigger point then you should be able to go back to a normal life. If you're a raging alcoholic you'll be ok for awhile, but the structual heart changes caused can cause afib from new part of your heart.
Personally, 3 episodes over 15 years, I wouldn't have an ablation. Ablation isn't always the answer I'm afraid.
Always difficult to comment on such a brief history. How long were the episodes and how were they corrected and was there a particular reason why a second ablation was suggested?
On the face of it, your AF burden looks very light and, without knowing more, in your shoes I would give myself at least a year to introduce more lifestyle changes and the reassess ie postpone the ablation.
My first AF episode was in 1993… over the following 28 years I had another 5 episodes. In 2022 they became more frequent with 2 episodes, 2023 only 1 episode and last month another. Last year we checked and my heart is sound just very mild dilation of the Atria so I’m know thinking it’s getting time for an ablation. All my episodes up to 2022 were caused by too much wine or caffeine then went off exercising, dancing etc… since then it’s been stress and eating too much too quickly and being dehydrated at the same time, dumb!
You should find out how sound your heart is first if no problems maybe some lifestyle changes I stupidly only initiated lifestyle changes in 2022. My last few episodes have been cardioverted and currently in sinus working out what to do next.
Me personally, I've gone down the path of medication. I have low burden at this stage with twice daily medication and lifestyle changes. I'm hoping changes I've made from identifying and avoiding triggers will reduce my burden further . This includes not drinking alcohol.
If I have an episode, the medications limit its effects (severity and duration) so I haven't been to ED since I started medication.
Your frequency of AF episodes would be the envy of a lot of people on this forum. It's a lot lower than mine and I consider mine low burden. There are various medication options you can try to overcome side effects you're experiencing.
There's no guarantees with an ablation. It works for a lot of people although not necessarily the first time and its lasting effects also vary.
The questions you have posed are best answered by your specialist. They will have full knowledge of your medical history and current health, which will probably influence his/her advice.
Whether you have the ablation or not, it's advisable to re-think drinking alcohol. Some research indicates "binge drinking may increase the risk of AF recurrence even after AF ablation". Binge drinking being >5-6 drinks at a time or binge drinking weekly or more.
Good luck with your decision.
I think if the suggestion came from your medical advisors its worth looking into. That said, 3 episodes in 15 years is not a high burden. I feel quite envious!
How do YOU feel about your AF? Does it bother you that much? Would you rather have a PiP regime instead? Or is there a particular reason your EP/cardiologist wants you to consider the ablation? Answering these questions might help you make a decision.
To my knowledge, only binge drinking episodes have been shown to trigger AF whilst persistent moderate to heavy drinking, especially in the presence of other cardiovascular diseases such as diabetes and hypertension, are associated with AF.
This is different from saying that alcohol triggers AF and that we should never drink. Of the several people I know or have spoken to about just this, and in myself, small quantities of alcohol seem to be a helpful and relaxing drink.
As for having an ablation to prevent future PAF, you have other good replies. Ablation, like medication, is for symptom relief in most cases, so your decision should be weighed according to this and the thought of the condition becoming more frequent, and perhaps permanent, in the long term. That said, two people I know with permanent AF cope admirably with it with one now in his ninetieth year. He has had no other treatment except an initial failed cardioverson and warfarin, whilst the other, 76 years old, has had several ablations over many years all of which eventually failed and he can have no more because of the scarring. Indeed, it is possible that the scarring may be the cause of the return of his arrhythmias.
Steve
Article from WebMD website
Does Alcohol Cause AFib?
Medically Reviewed by Nayana Ambardekar, MD on August 13, 2022 Written by Kara Mayer Robinson
A glass of wine with dinner is good for your heart, right? Although past studies have shown some heart benefits of moderate drinking, research hasn't shown a definitive link between alcohol and better heart health.
Drinking alcohol every day, in fact, can raise your chances of getting atrial fibrillation (AFib), a condition that makes your heart beat really fast and out of rhythm. AFib can lead to blood clots, strokes, heart failure, and other heart conditions.
How does alcohol increase your heart rate? Doctors believe booze disrupts your heart’s natural pacemaker -- the electrical signals that are supposed to keep it beating at the right pace.
So it's important to weigh the risks. Talk to your doctor about your health history and what makes the most sense for you. Learn more about health problems caused by alcohol.
More Alcohol Means More Risk
A recent study found a strong link between drinking one to three drinks a day (what doctors consider moderate) and getting AFib.
Heavy drinking, or more than three drinks a day, bumps up your risk even more. And it seems to keep going up the more you have. Studies suggest that for every extra daily drink, your risk goes up by 8%.
You don't have to drink regularly, either. Binge drinking, or having more than five drinks in a row, also makes getting AFib more likely. People in these studies drank wine or hard liquor. It's not clear if beer has the same effect.
How Much Is Safe?
You should avoid drinking alcohol if you have an abnormal heart rhythm. One study, performed in Australia, found that AFib patients who did not drink during a 6-month period had fewer AFib episodes.
If you're taking blood thinners, alcohol can raise your risk of bleeding. It can also be a problem if you take drugs that reduce blood clotting, like acenocoumarol or warfarin.
End of article
YMMV. We're all different and what you drink (wine, beer, spirits etc), how much and whether with food or not might all have an impact on whether your drinking contributes to or triggers AF episodes.
I do remember reading that a while back. Thanks for sending it again, though. It’s a good and useful account. I remember it sent me off to fine the primary evidence it referred to and what I seem to recall concluding was that there was still no solid scientific basis for the claims made in the article.
I will, though, search again since, for my last post, the evidence I found one cursory search was rather old (but no less useful for that).
What I think I’ll find is that there are so many genuinely complex confounding factors to account for when measuring the effects of drinking alcohol in moderation and the cause and frequency of AF that any attempt to link it with certainty is likely not going to be possible.
Certainly, the three moderate drinkers I know with AF do not consider there to be any link.
Steve
We're all different and it's entirely possible that alcohol in moderation doesn't negatively impact the AF of your acquaintances.
However, there's ample evidence there are risks from an AF perspective in drinking alcohol. As for finding support for that you only have to Google something like "link alcohol AFIB" and you'll find plenty of information including an article on the Northeast Georgia Health System website I have extracted the following from:
Cardiology experts have long thought that there was a connection between alcohol consumption and an increased risk of AFib. A study released in mid-2021 confirmed that fact.
In the study, which was presented at the College of Cardiology’s 70th Annual Scientific Session, data showed that having a single glass of wine, beer, or another alcoholic beverage doubled a person’s risk of having AFib within the next four hours. Having more than one glass tripled the risk.
The research study also found that for every 0.1% increase in a person’s blood alcohol level, his or her risk of having an AFib episode increased by 40%.
_____________________________________________________________________________________
YMMV because it's about risk. It doesn't mean it will cause AF episodes in everyone, it just increases your risk.
If this was an isolated report then I'd be looking up the supporting research as there's often more to it - and that might change it's usefulness or limitations from my perspective (It sounds like you do the same). However, I haven't bothered to because there's numerous reports scattered across the Internet that are all generally saying the same thing and I've already looked at details of enough to convince me. And yes, I can poke holes in some aspects of some studies but there's too many reports to not believe there's something to it.
You're at increased risk of triggering AF if you drink alcohol, even in moderation.
I can’t disagree with you nor fault your reasoning; neither am I advocating that we all drink alcohol. I would still have to say that, having worked on clinical trials in the past, although not involving AF, that the confounding factors must be huge and hard to account for. Also, from a quick search, I find that there are many articles created from very few studies.
It’s also perhaps worth adding that the body naturally produces small quantities of ethanol by yeast fermentation in the stomach and gut, so ethanol - in and of itself - is not likely to be arrhythmogenic. It then becomes a matter of dosage and personal reaction to it, and even to the concentration consumed, at least according the studies I have read (e.g spirits, wine and beer differ).
Also, it is a fact that beer easily bloats the stomach and can thus force it against the diaphragm, which can then irritate the heart and set off mild tachycardia, PVCs or PACs, which are considered precursors to AF in some people. Spirits can cause oesophageal contraction and irritation, and as many people’s food pipes press tightly against their atria, this can trigger PACs and AF. That happened to me while I was on a monitor in hospital - just gulping from a cup of tea.
So, to draw conclusions that it is the alcohol that causes the AF is not wrong but those confounding variables must be mightily hard to deal with. When trialists try also to account for a condition that is paroxysmal, often occurring very infrequently and sometimes asymptomatically, and which naturally is more prevalent with age, then yet more confounding factors need to be accounted for.
It must also be said that some individuals, religions and cultures dislike alcohol and might well be disinclined to see it in anything but a negative light. That is truly hard to account for in trial design.
In summary, I suspect individual trial and error is the best way forwards and, of course, a healthy moderation in all things, too.
Steve
Yes at the end of the day it's your life and it's up to you how you choose to live it. For some the risk is more than offset by the benefits they derive from having a drink e.g. social, relaxation etc.
I'll leave you with the following, which appears to be more direct evidence - again, not absolute - but adding further to the weight of evidence:
"For people who already have afib, alcohol appears to have a nearly instantaneous effect on their heart rhythm, according to a recent study. People in the study wore heart rate monitors and special ankle sensors to measure their alcohol intake. Researchers found that a single drink doubled the odds of a bout of afib occurring within the next four hours."
I have read the studies, including the 2021 study that the quotation is derived from and the 2016 study which seems to be another central one. I am only a little wiser since I last read other studies, now a good while back.
Still, the existence of the very many and varied confounding factors seems to me to be in the way of useful new information. I'll leave this discussion now with a different quotation, taken from the published study, rather than from the editorial:
"The findings also run counter to previous reports about the potentially protective role of alcohol on heart health when used in moderation."
On balance, I have concluded that we are perhaps likely better off not consuming alcoholic drinks, but that for an individual drinking an occasional glass of wine or a gin and tonic (my two favourite drinks!), they are likely doing themselves no provable long-term harm at all.
Thanks for the discussion. It's been interesting for me to re-evaluate the studies, but still rather disappointing that more certainty of a link between very moderate alcohol consumption and AF is still to be meaningfully shown.
Steve
I've enjoyed the discussion. It's always beneficial to be exposed to different views and informationThanks
One attack every five years is having no impact at all on your day-to-day life. I don't understand why ablation is even a consideration in these circumstances and suspect there must be a lot more to your story than we are aware.
So much misinformation posted here. If you have parxysmal afib originating from the PV's and it is successfully ablated you can go back to a normal life. Marathon runners who trigger afib from over exercise dont get an ablation so they can stop, they get an ablation so they can continue their training. Alcohol is a little trickier, but if ablation is successful then you should be able to have a drink or two when you want. Becoming a raging alcoholic will lead you down the path of heart disease and trigger afib from other parts of your heart. Why even get an ablation if you constantly worry about triggering the same afib the ablation is supposed to correct?
Why would you opt for an invasive procedure, if you have had only three episodes? There is medication, that one can have as a pill in the pocket. Makes much more sense.
I was signposted to ablation 10 years ago when I had very infrequent paroxysmal AF (once or twice a year lasting only a few hours; sometimes I'd go as much as 2 years between episodes). As several people comment below, I also thought ablation would be total overkill, best saved for the future if/when my episodes became much more frequent. The cardiologist who recommended it said that "You are the perfect candidate," but a second cardiologist pointed out that "Just because you're their ideal candidate doesn't mean it's the right thing for you to do at this time." This was backed up by a third cardiologist, who agreed with me that I didn't need daily medication with that level of frequency -- begging the question: if I didn't even need medication, why go for ablation? I also hoped that the technique and outcomes would improve by the time I did need an ablation, but I don't think the success rate has changed significantly since then. It's still around 60%, as far as I know.
My sister also has AF, has had it for decades, and finally went for an ablation last year (age 57). It has kept her AF-free and drug-free for 12 months, but she suffers additionally from chronic pain (unrelated to AF) and she found the ablation and recovery "too traumatic." She said that when the ablation eventually fails, she won't have another one; she will revert to a regime of medication.
I have paroxysmal afib with episodes every few months. I am having an ablation the 26th March. Although I find this scary my EP says it's best to have an ablation at this stage before episodes increase when the success rate is much lower. My EP who is renowned world wide says an ablation for me will have a success rate of 80%
I am sure you are being well advised. So far as I know, 80% rates of long-term cardiac catheter ablation success seem to apply only to specific cases and aren't completely operator dependent. Your specialist would likely have a good deal of information about your condition from scans and ECGs to be able to assure you of such a figure, but, if your symptoms are such that stopping the AF is the best course, then I would do the same as you're doing, for sure.
Steve
Thanks Steve
So your choices are either to have an ablation or to stop getting drunk... If I were you I would have an ablation. It seems like the sensible thing to do.
I would stop drinking, or cut down, as alcohol gives me tachycardia
When I was paroxysmal I had only 2 attacks in 18 months which one was too much alcohol combined with strenuous activity & 1 was with bronchitis.Doesnt mean I was a raving alcoholic.I then really cut down 2 very occasional drinking maybe out for a meal.I then switched to persistent 1 day after my 1st AZ vaccination 2.5 years of purgatory Still the occasional drink until a failed CV.I lost weight ,took more excercise & had a successful ablation a year ago.
The only alcohol I drink is maybe 1- 1-5 glasses of wine with a meal on holiday .Maybe 3 times a month .None at home.
I was a big drinker but don't miss it .
If I had stayed paroxysmal with 2 attacks in 18 months I wouldn't have had the ablation.If I had to rely on some of the meds or prescribed for AFib I would have gone for the ablation.The only meds I have ever taken for AF is Diliatazim and edoxaba.
Hope this helps weigh it up.
Do you still take an anticoagulant? I have been told I will have to take Apixaban for life even if the ablation is successful
Yes no problems with that.
As a person who opted first for Pill in Pocket with my paroxysmal Afib, but with increasing episodes chose to have a successful ablation, recovering fitness in 6 months,....I'd say...2 episodes per year resolved through medication, I'd stick with that. Any more and I'm going for the ablation no question. The other thing I learned was to trust the electrophysiologist. He won't do it if he/she is uncomfortable in your prognosis and he's only going to do it if they feel it will be successful. This is after all the person inserting catheters in your heart and poking holes in your septum and destroying good bits of heart cells....I apply the same trust and faith in their judgement on whether to do or not do the procedure. Best of luck!
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