I'm considering pulse field ablation for my dad and he is 72 with persistent AF. EP has suggested that he is a candidate for ablation. The risks are high and success rate is only 60%. I just want to understand if it is possible to manage AF on medication for long term. He is happier not having to go through the procedure. He doesn't mind having a cardioversion so he will go ahead with that to try and bring him back to sinus rythm.
How many cardioversions can a person have in their life?
Cardioversion is not without risk. Nothing is! That said I had at least four over the years, some of which lasted for a few months, one over a year and there are members here who have had a great deal more.
Personally I don;t think ablation has any greater risk and had my last in 2019 at age 74.
Ablation is invasive so worried about oesophagus damage, heart perforation etc. Just weighing the options as it may reduce his quality of life if there are complications. I understand that taking all the drugs can take its toll on the body.
Doctors keep saying AF is not life threatening so that suggests meds could work long term.
I thought that PFA was said not to carry those risks as it uses no heat.
Steve
I believe PFA is selective so it has lower risk than other ablations for oesophagus damage and heart perforation but it still had a risk. It's only based on what I read so an EP would be able to confirm.
actually my GP told me that AF is life threatening I have permant af welll controlled withvapixoban and verapamil was diagnosed roughly ten month ago I feel perfectly well though have no other heart issues apart from AF but when I said well it's not life threatening he replied yes it is and went on to say do you want me to lie to you
That's interesting and worrying and is different from anything I have read before. So far as I know, AF is "life threatening" in one area only, and that is a "by product" of the AF itself in that it can cause tiny blood clots to form in a sac in the top part of the heart called the atrial appendage. This then carries the life threatening risk of stroke and embolism. That can be prevented by anticoagulants such as apixaban. I think only a very few sufferers have AF of a kind that risks causing their blood pressure to fall dangerously low so as to cause fainting and the need for IV treatment in hospital.
Steve
AF itself is not life threatening, it is what it can cause if left uncontrolled in some patients. I have experienced an episode of heart failure...pulmonary oedema....some years ago when I did not get a cardioversion soon enough. It could have been fatal.
I think he must be referring to stroke risk.
yes he also told me he also has AF
It also depends if your heart is healthy to begin with. Mine fortunately is. It’s important to keep rate under control and within range, so as not to put extra strain on the heart. My cardiologist told me it wasn’t life threatening. It’s important to keep it managed and controlled, as we all know.
yes I agree that is the main thing I like you am fortunate enough to have no other heart issues my heart rate is very good obviously goes up when I exercise but am always careful and stop if it gets to around 130 to be on the safe side
Yes it's ok if you look after yourself and have the appropriate treatment. I wouldn't hesitate to have any of the treatments if my quality of life deteriorated. It is up to the individual as we are all different. It can be progressive as we know and although there is no cure, yet, we can halt it's progression and live a normal life. Thank goodness it doesn't come under the category of "terminal" and we can live a normal life span.
Agree
Hi
You have not given us his delimma of AF.
High Heart rate or low? What drugs for control?
BP high or low ? What drugs does he have.
Side effects of AF and meds.
Do fill us in please. We can give our experiences.
BBs did not control my high Heart Rate. 186 on Metoprolol. Breathless, Pauses at Night with Heart Rate 47avg bpm.
Introduced CCB Calcium Channel Blocker Diltiazem to reduce Heart Rate. Bingo shot it down to 51 within 2 hours. But 1/2 dose 180mg AM too much.
Now
AM Diltiazem 120mg CD. controlling H/Rate Day to 60s.
PM Bisoprolol 2.5mg controlling BP. Now 120-135 /. 82
PRADAXA 110mg x twice my chosen anti-co.agulant
I have been on this regime for 2.1/2 years.
2 operations (not heart) urgent - later. Anaesthetists pleased.
cheri JOY. 75 (NZ)
Hi thanks for this. Sorry should have said that his details are on my profile.
As Professor Richard Schilling once stated, "Any and all treatment for AF is about quality of life. " I would add, "so long as rate is well controlled and the patient anticoagulated where appropriate,"
Uncontrolled rate in AF can lead to heart failure and lack of anticoagulant to stroke and possible death but as I said nothing is without risk. Not even doing nothing. Life is a risks/reward equation but I understand we are all different in how we view and assess that equation so it is up to your father , after due diligence, what he wants to do. That said, after seventeen years of AF Association the number of successful procedures reported far exceeds the number of complications. Consider too that you are only told of the possibility so you can't sue the doctor if it did happen.
How many cardioversions can a person have in their life?
Probably patient specific determined by the benefit as directed by the doctor. Some forum members have had several.
Cardioversons are not considered a permanent "fix" though a few may remain in NSR. Most often they restore to NSR with follow up antiarrythmic drugs to hopefully maintain the NSR.
As BobD often says, treatment is really is about quality of life and the fact that afib can progress. Often, more than one ablation is required.
Would encourage to do more research perhaps to include a second opinion, 72 is not considered a negative in being a candidate for an ablation depending on other health issues.
Best to your Dad !
You're probably speaking to the right person here re cardioversions! I had my 28th just over 3 months ago and I shall be 80 in a few weeks time. These cardioversions have been spread , albeit somewhat unevenly over 30 + years. I don't know of anybody whose has had more but I expect there are.
As far as ablations go I had my 5th ablation 3 months ago. This was an endo/ epicardial procedure where the EP accessed heart through keyhole in chest wall as well as catheter entry through the groin. It went well.
As long as you are reasonably fit there doesn't appear to be a limit but I accept that I've reached mine! If I thought there were high risks I wouldn't have gone through all this.
These procedures are common place nowadays. Just make sure that the person performing the ablation is experienced. I hsve been very fortunate in having the same EP for all 5 of my ablations and follow ups since my first procedure over 15 years ago.
Thank you for sharing. That's a lot of procedures! You must be an incredibly brave lady. Sorry for asking all these questions.Did the ablations keep you AF free for a few years?
Did you have persistent AF to have the cardioversions and ablations?
Were you treated on NHS and if so that gives me hope.
Good morning Priya!
Yes , I was treated on the NHS for all my Cardiac procedures. I'm very grateful that my EP never gave up on me. Bear in mind though that I was a difficult case and refractory to drug treatment.
The ablations left me mostly AF free for up to 2 years , some less . I was getting rates up to 240+ bpm before my 4th ablation so that kept the rates down to under 200, many 140 ish.
My episodes were persistent ie they would not revert to sinus rhythm without intervention. All of my cardioversions were ' emergency' as opposed to ' elective'. They were as a result of presenting at A&E with unrelenting fast AF (or flutter) which could not be brought under control. So no waiting lists for me.
Hope that helps with making a decision. I'm happy to answer any questions you may have!
Best wishes
J
Priya, can I suggest you get a second opinion at a leading heart and lung hosp EFvconsultant.
I transferred to Brompton, was also sent to see another consultant to check I had no heart failure caused by the AF.
That was clear do they did an ablation soon after.
My AF consultant very much believes to do ablation early before any heart damage.
I was 70yrs old and have had only 1 AF episode since due to lack of potassium due to a bad IBS episode
I take rivaroxaban daily
Bellaowl
Hi
A friend of mine on his 3rd was told NO MORE. re ABLATIONS and all his has been catheter related.
He is now focusing on his athritis in his hip. Due to a titanium hip replaced after motorcycle accident. At night he takes panacetamol and codeine.
cheri JOY
Hiya priya_uk
I was diagnosed with paroxysmal AF in Jan 2010, aged 65. I have been following the medication line ever since. On discharge from hospital back in the day the Cardio Consultant who had been treating me discussed a number of ways forward - one was an ablation which I rejected out of hand. He duly referred me back to the care of my GP. Been on medication ever since. I was referred for cardioversion and on the day I was found to be back in NSR. Why not - its paroxysmal ! I was also originally diagnosed as being asymptomatic at the time !
At the time of discharge I was already on Simvastatin and Ramipril. The Consultant then added to the mix ... Warfarin ( in 2010 these NOAC's like Edoxaban didn't exist for patients, probably still in the laboratory ), and also Bisoprolol 5mg. In 2013 I was then prescribed an additional med ... Felodopine 2.5mg. after I moved to Cornwall.
Bisoprolol has been the only one to give me a really odd issue, ( violent. random, full flow nose bleeds - solved by changing the time I took the medication from morning to night ) even so I stayed on it for over 13 years and last year ( August ) my GP switched me to Nebivolol 5mg. ( still a beta blocker though ).
Earlier this year, March time, my heart started to kick off again and I went private selecting a South African Cardio Consultant who trained and qualified at Groote Schur Hospital, Cape Town. He elected to maintain the medication line I was on but replaced Nebivolol with Sotalol 40mg morning and night ( a total of 80 mg a day ). And so .... hey ho ... all is well .... the only side effect that I find annoying is the tiredness , but then, I've had that with Bisoprolol and Nebivolol too over the years.
Still alive to tell the tale despite my new Consultant still agreeing with the original diagnosis --- paroxysmal and asymptomatic. My Sotalol meds are up for review next month. I must say though, throughout my life I have never had side effects from any drug I've been prescribed ( except Edoxaban ) and I have made my GP very clearly aware that I will never take it or any of its 3 other buddies ever - so don't go there I told her.
Also, looking back on your post - I retired formally at 65, but got bored after a while and went back to bus driving..... I've remained a bus driver ever since finally retiring on 5 July 2024. Yes, even while taking all this medication - which as we write consists of Simvastatin, Sotalol, Ramipril, Felodopine and Warfarin ... basically all the same classes of drugs as I kicked off with in 2010 just changed with a slightly different emphasis to problem solving.
Like Jalia I turn 80 in a few weeks.
Good luck and success with your Dad. Any questions, ask away.
John
Hi John, thanks for sharing. You are amazing, driving a bus whilst on these medications is truly remarkable. The fact that you have managed with meds gives me a lot of hope and also gives my dad an option.
In a previous post you shared how you measure INR at home so that was very useful in case he has to change apixaban to warfarin.
Hi priya_uk,
I should have said that right from the get go I declared my AF to DVLA and my medication. Life got more tedious as I shifted into my 70's as I then had to have a medical annually ( a DVLA requirement for bus drivers ) , but even so everything was declared to DVLA, including the name and address of my GP and my employer. My only medical conditions were and still are AF ( al beit, highly controlled ), and osteoarthritis in both shoulders.
If you go down the Warfarin road you will need to find an INR Clinic near you, ( in my case my surgery has its own INR clinic staffed by two nurses who do all the work on their computer ). Maybe your own GP Surgery has its own INR clinic but you just don't know it maybe because it has never been a concern in the past.
In my case my INR clinic establishes a base line INR test date. I do the test, first thing in the morning, phone the result into the Clinic. The Clinic phones me back a few hours later, tells me the new dose and the next test date. Every 10 weeks we agree that I take my device into the INR Clinic and we do a joint test .... I do a pin prick on a finger and squeeze drop the blood onto the Clinic Test Strip and from the same puncture wound on the finger of choice onto my Test Strip. We then compare the reading results ... historically the difference is usually +/- 0.01 between the two devices. So that way we keep a check on the accuracy of my device.
The cycle just keeps repeating over time. I do suggest you 'Google' a subject such as Food and Warfarin or Food and INR and have a look at thoughts on diet. I'm very fortunate in that food and drink, particularly alcohol, have no bearing at all on my INR test results. (I'm as normal as a grumpy 80 year old git can be 😂😂😂 ). The UK website BANT have useful stuff on diets.
Roche are the manufacturers of the Coaguchek XS PT system that is pretty universally used these days and you may wish to do some research online through their website ( or any other for that matter ). Once you get used to it, its as easy as falling off a log. After all these years and study of Wafarin and how it behaves I can now confidently self dose and determine my own test dates. As I may have said previously I have had three medical procedures which have required me to stop and restart Warfarin ... again, no sweat.
Anyway, going forward I wish you well in any process you opt for.
John
I have been on Flecainide - metoprolol for 9 years. I'm 69 now. I have an episode on average every 8 months. But if I was having episodes every week I would get an ablation and hope for the best.
My dad was on flecanaide for 7 years. Now that it is persistent we have to decide what to do.
Dear priya…Of course you are concerned about your parent but I urge you to look closely at PF ablation. I am 18 days out from my PFA at a top Boston hospital. I am 84 years old , have had afib, aflutter, and tachycardia for 7 years. Had failed on Flecainide yeard ago, and was beginning to fail on Tikosyn. Having no other major illness, I was considered a good candidate, despite my age.
Now comes the bit of Irony..I somehow developed pneumonia from procedure and am recovering from that. COULD HAPPEN TO ANYONE! I guess. The good news is ablation went well. Zero issues with pain or other ablation related conditions. However we all need to do these things eyes open. It was the right decision. Time will confirm or not. Healing the lungs from pneumonia today.🙏🙏Good luck.
Hello, thank you. I agree with you. In fact I have been passing this forum's experiences to my dad and we can see many have successfully had it. Very kind of you to respond to this thread whilst still in recovery yourself. Sorry to hear you developed pneumonia and wishing you speedy recovery and sinus rythym for years to come. All the best.
I was getting AF 3 to 4 times a week, sometimes lasting hours or even days and my quality of life was very poor, so had an ablation in May 2018 and have not looked back since, still AF free now 70, my meds for heart related problems is rivaroxaban, which I was informed I would now take for life now, so ablation for me was a no brainer.
Thanks. Good to know you would recommend it.
Had my ablation in March 🤞 still AF free, long may it continue had awful episodes previously
This is the stance of EP John Mandrola, who has performed hundreds of ablations himself:
“AF ablation is a big deal. It is not for the faint of heart.
• It requires 3-4 hours of procedure time with either general anesthesia or significant sedation and an considerable dose of harmful radiation.
• A harpoon-like needle has to be poked across the beating heart in a patient on blood thinners.
• Over a hundred burns are made in the most sensitive of the heart’s four chambers.
• In low-risk young patients–a minority of AF patients–the procedure successfully eliminates the AF in only a modest two-thirds of cases.
• Almost half of these successes need to have a second procedure to touch up areas that “grow-back.”
• Complications are real. There is a risk of stroke, heart attack, perforation of a perfectly good heart, pulmonary vein stenosis, air embolism, esophageal damage, and of course death. The overall complication rate is low, but since AF is not immediately life-threatening, any major complication becomes even more magnified.”
Thanks for sharing this. When it goes well it's amazing but when it doesn't we don't know how it's impacted quality of life for patients.
Gosh, if everyone read and believed all of this I would think no ablations would be carried out I had a long discussion with my 'highly regarded Professor EP' who informed me of the risks and benefits. I decided I couldn't continue with severe symptomatic episodes lasting 36 hours, it was controlling my life.
I had the ablation in March and whilst the first few weeks were uncomfortable with some digestive issues things settled down and I have been AF free ever since.
Yes, it's not for the faint hearted but give me one procedure/operation that is without risk
Thanks for sharing your perspective.
Blooming heck, if you gave a detailed description of a triple by pass or heart valve replacement similar to that mini novel nobody would ever have it done!!. Even a hip replacement is very gruesome if you seen how they do it. You are clearly against ablation procedures and this is the second time I have seen your explicit details of the procedure as relayed by a cardiologist friend of yours?. I had mine 9 days ago and am happy to say I am back to normal with no Afib episodes so far and feeling great. I think the gory details of any operations are best left to those that carry them out and all the patient needs to know is the risk factors, which in the case of catheter ablation are very small indeed. Oh and the success rates have vastly improved.
Agree with everything you say 💯
It’s all a matter of balance, like everything in life. Atrial fibrillation is a benign, non-lethal condition, provided anti-coagulation is properly addressed. In that case there is no difference in mortality or life expectancy between people who have AF and those who don’t.
That means it comes down purely to quality of life. For someone with permanent AF, with a heart rate that cannot be brought down by any medication, that quality of life is seriously reduced. In that case, ablation is a viable option.
In other cases, where the incidents are relatively short and far between, and with proper rate control, quality of life can still be excellent, especially if the patient has gotten used to the condition. Some patients even claim that permanent is better than paroxysmal, just because the chances of ‘getting used to it’ are better.
In those cases ablation should be approached with due reserve, because the disadvantages and risks might very well outweigh the possible benefits.
I often read here that ‘AF is always progressive’. This is absolutely NOT always the case. In my own family, two members who had AF for years. and numerous cardioversions, have seen their episodes reduced over time by adjusting their lifestyle and diet.
As for myself, I have been on Sotalol, and later on Flecainide to stay in NSR, but eventually both meds allowed so many breakthroughs (almost every other day) that I stopped taking any anti-arrhythmic. I am now in sinus 95 % of the time without rhythm meds, taking only supplements: magnesium taurate, D-ribose, L-Carnitine and Ubiquinol.
My point is: any honest cardiologist or EP will admit that ablations are offered too often or too soon, especially for patients who have only a few episodes per year, with their heart rate under control. Then the profit/risk balance is not OK.
By the way, the comparison between valve or hip surgery, or a triple bypass operation and ablation is a misleading one. In the first leg of the comparison, things are being ‘repaired’ with a certain, well-defined outcome. In the case of ablation: a thing (the heart) is being severely damaged with an uncertain outcome. That’s a world of difference.
Thanks. It's remarkable that you are just on supplements to maintain sinus rythm. I read up on these supplements and they look really good for heart health. Ideally if they work, then I can't see a better approach.
Doctors always go for standard anti-arrythmic drugs and to some extent its because there is evidence and research to support their use.
I also read that drugs like Flecainide may exacerbate arrhythmias which was eye opening.
On the other hand there is very little research on supplements for Afib obviously because there is no funding for such trials.
Just interested to know how you identified these supplements and whether your doctors are supporting your approach.
When my dad's AF episodes were infrequent back in 2017, a couple of EPs told him that it wouldn't be necessary for him to have an ablation. He was mostly in sinus rythm until early last year with approx 35 episodes between 2017 and 2022. Last year his episodes started increasing. Now of course he has developed persistent AF and heart failure so the situation is very different so I'm exploring options.
If cardioversion brings him back to sinus rythym, I am still interested in how supplements can help him maintain that.
I researched all possible solutions together with two friends, a GP and a retired cardiologist (who has AF himself).
We found out that my AF was vagally mediated, with typical triggers such as ‘during sleep’, ‘after a meal’, ‘from stomach pressure’, etc. For this kind of AF, in the scientific literature, the most efficient drugs listed are Disopyramide and Flecainide.
My treating cardiologist then prescribed Flecainide at my demand, which worked for some time.
But eventually, during a period of extreme stress, I had breakthroughs almost daily. My regular cardiologist, a highly regarded professor, then advised to take an extra 200 mg of Flecainide per day, which brought my dosage on some days up to 400 mg! ‘If you then still have breakthroughs, add another 200 mg’ he advised. That would have brought my total daily dose at 600 mg, whereas in the literature 300 is mentioned as’absolute maximum’.
I felt awful on 400 mg, with very unpleasant and potentially dangerous pre-syncopes when I reverted from AF to sinus. Then, in consult with my friend GP, we decided to stop the Flecainide altogether. We both thought I was poisoning myself!
I told the professor and he started talking about an ablation, although he knew very well that I was not in favour of such invasive treatments for a condition that is not life-threatening. I decided that I needed another cardiologist, and in the meantime did some more research myself.
I then stumbled on alternative solutions when searching for other meds. The trio D -ribose, L-Carnitine and Ubiquinol caught my attention. I decided to give these a try.
Since then I am in sinus most of the time, with periods as long as 7 to 8 weeks. When I get AF, I take 1 dose of 250 mg Flecainide as ‘pill in pocket’, which will convert me to sinus in 3 to 4 hours.
Because it was so obvious that stress and worries (about AF) exacerbated the condiction, my friend GP also advised me to take a low dose of the anti- depressant Sertraline. Probably the anti-cholinergic properties of that drug also helps keeping g AF at bay.
So the first, and most importantly thing to find out for your father is: is his AF vagally triggered? And start the search for solutions from there. Don’t believe that AF is always progressive. From my daily episodes cluster that lasted for 3 months (!) I went to 1 short episode in 6 weeks on average.
A cousin of mine who had persistent AF went from that to nothing! My mother lived to be 94 with AF and ‘had the heart of a young girl’, her cardiologist said. So it does not always lead to heart failure, either.
All the best for your dad!
Thank you so much for sharing this. This resonates with me because I know that my dad believed his AF episodes were linked to eating e.g. eating a slightly heavy meal, eating food that didn't suit his tummy etc. At first it sounded very strange but as I read more about the vagus nerve I am convinced there is a link.
Also he has psoriatic arthritis which is an autoimmune disorder so his body goes through all sorts of inflammation. I did suggest that he take magnesium supplements but then we were worried that if it changes the balance in his body, that could trigger AF. So perhaps we need to test his magnesium level.
So how do you know whether AF is vagally triggered. Is there a test or is this simply from personal experience of what usually triggers your AF?
Your post has been incredibly helpful, thank you.
Vagally triggered AF typically presents itself at rest or during sleep (as opposed to: from exercise), with pressure on the heart from a bloated stomach or a big meal, when burping fails, when bending over, when getting emotional or stressed out, when worried about…. AF, when pre-occupied with AF (throw away those Apple Watches, Kardia’s and other reminders of HR), etc.
I’m quite confident that in the future, AF will be treated by influencing the vagal nerve instead of the electric system of the heart itself.
So, convince your dad not to worry too much. That is a very important part of the cure. In fact, I had promised myself never to come back to this forum again, for exactly the same reason (many of the posts promote worrying), but I’m gladly making an exception for your dad.
Wish him all my best!
I must not forget to add that I also take. Bisoprolol and Lixiana, after a heart attack and 3 drug-eluding stents 6 years ago. The betablocker Bisoprolol keeps my HR within acceptable and comfortable limits when and if there is an AF breakthrough.
Some people here think that I am strictly against ablations, and even use insulting languages because of that. Let me make this clear: I’m not ‘against’ anything.
If my AF would be accompanied by fast flutter, making my life miserable, I would certainly consider an ablation.
But for people with paroxysmal ablation, whose HR is under control (between 60 and 100 at rest) I- and my medical friends- find the procedure too invasive, damaging and risky.
All 3 of us feel that the expensive -and beautiful- cathlab-equipment needs to be used as much as possible and that, for this reason, ablations are offered and performed way too quickly, without first trying all other approaches. An ablation in my country costs between 8000 and 12.000 euro’s. It’s a business model as well as a cure. Sometimes.
Thank you. I completely get that. I think people speak from their own experiences. I am coping with my own health issues since my 20s and I learnt that half of the diagnosis and treatments I was offered decades ago were not relevant because my condition was not well researched or commonly known about then. It's because medical solutions are meant for populations and based on population studies. They are not tailored to individuals. Each person has their own comorbidities and very different situation.
Ultimately each person has to take a holistic view of their own health and make a decision.
I value all the opinions for this reason, even edge cases. Everyone has something to offer from their own experience and it will benefit patients.
I am not opposed to ablation either but I want to ensure I have explored alternatives properly so that there are no regrets later.
Thank you for kindly sharing your approach to health
I don’t think that was written recently. Techniques and skill have improved since then and more people are having ablations as a first choice rather than a last resort, ie while they are still relatively fit.
My EP told me that age 70 in their team was considered young and they perform many cryoablations for people in their 80s. I was glad to get out of persistent AF and have been enjoying NSR ever since. If I ever need another ablation I’ll take that tiny risk. In the end we can only face those tiny risks involved in every medical procedure for ourselves.
it’s harder to answer not knowing his background but I’m still exploring Ablations. The PF ablation is newish and approach lot quicker and less risks. I’ve read that results are on par but not better than RF ablations. When they did the Study I believe it was Generation one technology, some manufacturers are now on Generation 3 models. It would be very interesting to see comparisons if other studies are done. In addition there is an Australian company Imracor that had developed an MRI guided Catheter which promises to be far more accurate than the current methods I think using Xray. It has commenced trials in a major US Hospital on patients with Atrial Flutter and also in Europe. I am watching keenly and waiting to see results. The idea being the doctor can see much better detail and therefore 2nd and 3rd ablations might not be required
I am 66 and have had 3 episodes since 2022 and 3 cardioversions, prior to that the previous 30 years one AF episode on average every 5 years. So the point is my triggers were and are alcohol caffeine over eating and stress. I’ve managed that now and have always kept fit which could be the reason my episodes were so spaced out or I could be just luckier than some. After the last episode end of January I decided to try very low dose Flecainide and low dose metoprolol, so far so good. My doctor jokes that I’m just above homeopathic doses!
I also checked my bloods and was low on Vitd3, magnesium and coq10 and after speaking to Cardiologist he was ok for me to supplement. I now wait and see the advancements in these new methods. Your father will be told if his heart is structurally sound and if so the medication route maybe an option. Certainly the PF appears to have less risks if he decides that route
I have been taking bisoprolol since about 2015. No other interventions. I was put off an ablation at the start by a consultant who told me in a doubtful tone “that ablation was not without risk”. They clearly wanted to put me off and I am not a risk taker. I didn’t want my heart zapped either. So I have pursued the meds route. No regrets at the moment. Hope you work out your way forward.
Thanks. Is your AF paroxysmal or persistent? Things haven't always worked out well with risk taking in my family healthwise so it just makes decisions more difficult.
I'm 73 and awaiting my 1st ablation after cardioversion onlyvwirked for a few days....prev one had lasted 7 years.
My cardiologist said 60% of ppl stay in sinus for a year or more which is different to a 60% CoS. That said all are different so only your fathers cardiologist can verify that. That figure can apparently be improved on with weight loss/exercise, tho again cardio advice may vary depending on other conditions.
My EP told me 80 to 85% if the first ablation is done when still paroxysmal and early stages.
I have mistakenly replied to Bob (whose opinions I always value) in this thread but I meant to reply to you!
hi I agree with leechg I permant AF well controlled with med feel perfectly well no other heart issues never had ablation or any other procedure mentioned to me personally I'd avoid surgery unless it was absolutely necessary
Thanks for sharing your perspective.
This is such a tough decision for you and your father ...
I personally have an aversion to invasive procedures, neither am I keen on medication, however I can see from these posts that for many there comes a time when AF is too frequent and intolerable, or the drugs are intolerable .. so the choice is a matter of QOL ...
Would I want to stay alive feeling horrible all the time, or take that risk? It's a hard one, many on this forum are lucky and have a positive result from ablation, some not so much ...
I don't know what the statistics are of success and failure, if they exist?
For me PAF happens every month or two and is horrible. The PIP Flecainide that gets me out of it, has a disturbing after effect. Reading these posts I realise if the episodes were more frequent or lasted longer I would also be pushed to consider ablation.
Thanks for your post, and to everyone for sharing their experience - it's helpful.
I think you very accurately stated the dilemma many of us experience. Where is the line between what's tolerable and intolerable regards Q of L when it comes to deciding risk/reward. I'll add one thing I tussle with, the risk of living with regret if my assessment is wrong.
I was like you but my episodes were very symptomatic lasting 36 hours but coming every 3 to 4 months. I couldn't see myself suffering like that for the rest of my life especially as AF almost always progresses. My EP told me the sooner it is treated with ablation the more chance of success. I had mine (after doubting myself many times and almost running scared) back in March this year. The recovery was a bit bumpy but the best thing I have done up to now. No episodes since January this year. Long may it continue
Bear in mind Priya that anticoagulants in PAF reduce the risk of ischaemic stroke by only 60%. Ischaemic strokes are considered the most disabling.
With time, a consensus will form around surgical intervention in AF.
Until then, my opinion is that patients need the very best available advice from EPs in the USA, Bordeaux or Japan.
There is no substitute for the accumulated expertise in a particular technique of a given top EP who I imagine is driven more by reputation than revenue.
The stamina demanded for 3-4 hour procedures will take a significant toll on a man older than 55.
Gosh I wasn't aware antocoagulnts only reduced stroke risk by 60%. Thanks for sharing that.
I have expanded on my post above and would be glad of any further comment.
Forgive my presumption, is your father’s reluctance to engage with the forum a reflection of a decision in his mind already taken?
What is your own instinct?
Only reason for him to not engage in the forum is that he is quite frail. He is coping with Psoriatic arthritis without meds since he started Apixaban which is debilitating. His worst health problem is psoriatic arthritis as its an autoimmune disorder. His quality of life has already been greatly impacted by it.
I'm just helping out to make sure he has different perspectives before he makes any decisions. His mind is not yet made up.
He is concerned about any risks from the procedures further debilitating his life. I don't think he would cope if it did hence all concerns.
Psoriatic arthritis is hell - I have a friend who has it. I don’t know how your father copes without treatment. Regardless of an ablation for AF the answer to your father’s problem with Apixaban would be a closure of the left atrial appendage which also reduces the risk of stroke and means he would not need to take Apixaban. Has anyone mentioned this to you?
What 3 to 4 hour procedures are we talking about .... general surgery or cardiac related surgery ? Maybe I have plenty of stamina to survive a 3 hour knee replacement which has contributed to an excellent healing. Had to stop Warfarin for 6 days and return to it post op. I was 71 at the time.
Sorry I was referring to the surgeon! I wonder how many such long procedures are done standing under hot lights by men approaching retirement.
I am 67 female and my ablation was performed under sedation and took almost 4 hours. I was very scared and almost chickened out, but I did it and glad I did. To be in NSR is so good and I have just had the confidence to go abroad for the first time since I was diagnosed in 2020. My EP said to me "Just imagine you have boarded a plane to Barbados and you go into AF". That was the deciding factor for me!
Thank you Priya for giving such pertinent context. Complication rates and prospects of recovery from same, must diminish with advancing physical rather than chronological age.
Frailty both mentally and physically suggests to me from a distance that the risk/ benefit ratio is likely far too high. Has you father consulted his GP about this?
Yes I agree with you physical rather than chronological age matters. Also how mentally prepared one is matters for such procedures.
GPs hardly have the time. Unfortunately we have to remind them of his medical history every time and that leaves very little time to get anything from the 10 minute appointment. It's just how things are and I know NHS is under pressure and everyone is trying to do their best so no complaints.
I have already sought advice from private EP but will get a second opinion. I think I might wait until his cardioversion is done so that we can know what his state for Afib is after that.
My first question is, What is the current level of quality of life your dad is having. Because that is what is being risked so to speak. Whatever invasive procedure being considered starts with that question and risk/reward is measured against it.
It's a very good question and one we need to think about. I feel his physical quality of life is lower than other people his age mainly due to the long term arthritis and auto immune disease. However mentally he is very good. Like you said we need to measure risk/reward.
I don't often respond to things on this site, but read most posts everyday. That said, I was diagnosed with AFIB in 2020 at the beginning of COVID. In the first event I was treated by a GP in the ER and then assigned to an EP for follow up. The GP certainly had, and was certainly entitled to his opinion but the EP is the real authority on AFIB. Even and regular Cardiologist is well informed about AFIB the EP should always be the final word. When I was first diagnosed, we went through several medications and upon recommendation from the EP I was placed on Sotalol, 80MG in the AM and 40MG in the evening along with Eloquis, 5MG. To this date my AFIB has been under very good control. As with any medical condition, a bit of long-term management requires some behavioral modifications. If the patient subscribes to the modifications AFIB is manageable. The most important thing is to manage it properly and be aware that blood clots in the Left Appendage can be lethal and as my EP says, an AFIB related stroke from the Left Appendage is "never pretty".
Thank you. Appreciate your comments on this post. May I ask if your Afib is paroxysmal or persistent?
I'm try to understand what keeping Afib in control means for those in persistent Afib. Is it about keeping HR in the 50-99 range through meds or does it mean something else.
Many thanks
That’s it - controlling the average rate. I do think some meds might ‘smooth’ the AF a bit and it seems that once people have been in Permanent AF for a while it becomes less symptomatic.
After experiencing full-time afib for nearly a year before an ablation (this was about 15 years ago, before the pulse kind), and the wonderful relief of sinus rhythm, I would definitely do it again! And actually have, twice. At 77, though, I'm done. But I'd take the new ablation method over lifelong medications every day of the week, especially if in permanent afib! The risk is minimal compared with the downside of meds and afib.
I’ve had persistent AF for about 7 years. Daily medication and moderate exercise. I’m 86
Hello Priya_uk,
My father had afib and he was on medication for approximately 50 years and he never needed an ablation procedure or cardioversion. His medication handled his afib quite nicely. I wish medication worked for me.
I hope this helps with your decision for your dad.
Thank you. That gives me Hope. Presumably it was paroxysmal for him rather than persistent. For my dad I'm hoping that it returns to normal sinus rythm after cardioversion and then we can consider whether meds or ablation needed for future.
I had a successful ablation well into my 70s. Best decision I ever made. 70s may seem old to you, but for those of us in our 70s we still feel like we have a lot of living left! An ablation can potentially allow your dad to live the rest of his life afib, free, and without all those medications and side effects which can slow you down. And getting into rhythm can help protect him from heart failure down the road. Just make sure he's getting an ablation at a high-volume center, that can make all the difference. The statistics you quoted are very conservative. It's closer to 80% effective or even 90% if you allow for a very occasional a fib episode once or twice a year.
Jim
Thank you Jim. That's positive. I don't think 70 is old.I am only asking what options are possible with meds vs ablation.
My dad has other comorbidities so he has to weigh the risks and this is a difficult decision for us.
I can see a lot of benefits for ablation and I can see that a lot of people on this thread have recommended it. This has been very helpful.
Another thing that prompted me to get an ablation in my 70s was that I afraid if I waited to my 80s, I may have more comorbidities making the ablation more difficult. It is not an easy decision but many of us have had successful ablations here.
Like with most health forums, those with successful procedures have left the forum to go on with their life, meaning forums like this tend to be skewed toward negative outcomes, because they need continued support.
Jim
Presumably this wasn't a response to me as I have not made such remarks. All the best.
I had an ablation at age71 ten months ago. I would say by and large it was a success. Took me a couple weeks to recover but have been active since, indoor cycle, light weights, walking, and tons of yard work. Had a period of high anxiety from an external stress and did slip into light burden afib (not severe and very short spells) so I put myself back on blood thinners and cardiologist put me on Multaq. Have not had a reoccurrence since.
Thank yiu for sharing. Good to hear of more successes with ablation. All the best with your health.
Thank you everyone for sharing your experiences, it really does help in making decisions easier. If I learn anything new in my journey to explore options for my dad, I will post it here. All the best for your health.
Arrhythmia after ablation
Persistent AF(ib) after Ablation
Feeling rubbish after ablation
