afib ablation, recommend, advise please

[Afibbingnewbie]

I have had minimum 3 episodes of afib in the last 8 weeks , lasting up to 24hrs , at what time would it be considered right to have the recommended ablation ? IE will it just reoccur if I don’t have the ablation, TIA

[secondtry]

Have you tried any medication first?

[Afibbingnewbie in reply to secondtry]

Yes had meds , cardiologist says I don’t have to do it immediately , Be will likely back in his office having the same conversation after another episode or two

[BenHall1]

I think you have a way to go before an ablation would be considered .... certainly the medication route would be first choice. In any event here in UK you are unlikely to get an ablation 'quickly' on the NHS. You'll get it quicker going private but at a price.

Have you seen a Cardiac Consultant or an EP, if so what is their view ?

[CDreamer in reply to BenHall1]

I have several friends who had ablations within weeks on the NHS last year, bit of a postcode lottery though as in Devon it was a long wait. Funnily enough the private wait list was about the same, mainly because of restricted access to Cath Lab.

[BenHall1 in reply to CDreamer]

I have to say, I have no idea what the situation is here in Cornwall - probably NHS is no different to Devon. We only have one major NHS hospital and maybe 2 (maximum) private. Apart from that its Plymouth. So if anyone thinks I'm driving or taking public transport from 10 miles outside Penzance to Plymouth they can dream on. I just thank goodness all my ailments are highly controlled ( for now, anyway). 😂😂😂

[Afibbingnewbie in reply to BenHall1]

I have tried medication and it doesn’t seem to do the job. I have been seeing a private Cardiologist I i’m lucky to have medical insurance Cardiologist says that I don’t have it immediately but will likely be having the same discussions in a few weeks or months . I don’t smoke I am not overweight

[CDreamer in reply to Afibbingnewbie]

It would be useful to know which meds you have tried? Rate control or antiarrythmics? The

[CDreamer]

I think it will depend upon many factors, your age, your fitness levels, your lifestyle. In hindsight I would have done a lot more to mitigate my lifestyle before taking any treatment. Ablation is more likely to be long lasting if you are in your best possible condition, don’t drink alcohol or smoke and many will say - the sooner the better.

I am someone for whom medication harmed so for me it would be straight to ablation, if I were under 50, in the best possible fitness condition with no underlying co-morbidities such as high BP, diabetes, thyroid etc. In older people who are less fit, AF is more likely to return but again depends upon many factors.

A significant factor is also how symptomatic are you?

Everyone’s journey is vey personal, for some medications help, others need more invasive procedures when AF is very symptomatic and QOL is affected ie: you cannot carry on with your normal day/day activities.

Hope that helps.

[Buffafly]

Latest thinking seems to be the sooner the better for an ablation but it’s more likely to be successful if your lifestyle is as healthy as you can manage. Stress is the worst thing for AF so if you have a high powered job or have a very ‘driven’ personality you may have to work on your stress levels beforehand if you hope for long term success.

[Ppiman]

I think it is down to what symptoms you get and how well you cope with them. I am awaiting an ablation but as I am currently coping "well enough" with my weekly / fortnightly AF and daily ectopics I am wondering whether an ablation is the best way. The answer is likely "Yes", I am guessing since if the symptoms were to become more frequent, it would not be easy to cope.

Steve

[Vonnegut]

Haven’t you been offered something like Flecainide which I used to take as a “pip”? It stopped episodes in a few hours and now that I take it regularly it has virtually put an end to episodes. Of course, we are all different and I was prescribed mine by an EP I saw privately after the lowest dose of Bisoprolol proved too much for me to take daily,

[Cliff_G]

There is increasing opinion that ablation should probably be seen as a first line treatment. Meds have in general only a percentage success rate, some get good relief, some don't. In general, AF does tend to worsen over time, under the AF-begets-AF remodelling mechanism, that is unless you can successfully implement lifestyle changes which help, and it can be difficult to find the right combination.

It's still true that ablation will be easier and more effective if it's done while the AF is still paroxysmal and before it goes permanent.

Also important is to find a good EP (and a well equipped cath lab) with a high success rate.

[BenHall1 in reply to Cliff_G]

I think lady luck plays a big role in this, moreso in todays NHS, than when I was first diagnosed in Jan 2010. I was originally diagnosed in 9 hours of onset of what I thought was ' me goin' down with flu' !! Not flu at all .... paroxysmal AF, soon put on Warfarin, kept in hospital a further 4 days for tests etc then sent home ............. medication route ever since. In the almost 15 years on this current forum and its previous incarnation ... I've never read anything like that speed of diagnosis and starting of treatment and tests etc.

In effect this speed really never gave my heart a chance to remodel itself into the naughty AF ways. Still don't regret going down the medication route as opposed to ablation.

[ozziebob]

Important to have full blood tests to look for any deficiencies or irregularities that might be a factor in the aetiology of your AF.

In my case a vitamin D deficiency was only discovered when my AF was diagnosed. And, after supplementation, the initial frequency of my AF events every 30 days was reduced to about every 100 days. Not insignificant!🤔 I currently have the anti-arrhythmic flecainide as a PIP (to use when the need arises), and this is my only medication.

It's worth remembering that GPs in UK do not routinely authorise Vitamin D tests, although I know nothing about such access in private medicine.

[Cliff_G in reply to ozziebob]

You can now get at-home fingerprick tests now. Oddly enough mine should be arriving today. There are many on Amazon but not many of those look too credible, some are yes/no with a lateral-flow-looking tester. I picked a different type which looked ok and pretty professional, and went to their own website to check out (and order). They give you a proper report (example on their web site) with recommendations, and are UK based. PM me for the name if you want.

[ibuputih]

Hi - when I was diagnosed with AF about 10 years ago, monitoring showed I was in AF around 27/28% of the time. I was told that the sooner I had a cryo ablation the better. My cardiologist’s opinion was to whack it before it got a hold (my words not his!). He thought I would be a good candidate and the EP agreed.

I was seen and operated on privately. The process took about 4 months from initial consult to ablation, while they juggled with Warfarin to obtain an optimum INR for the op.

I was very apprehensive - but it worked brilliantly.

[Desertflowerchild]

The earlier one has an ablation after diagnosis the higher the success rate - that is my understanding of the state of the medical knowledge. But, as the success rate is usually measured at one year for a cardiac catheter ablation, that metric may have limited utility.

I had a pulsed field ablation at the beginning of this month and still feel I could have gone either way on the decision. At this time, just shy of a month after my ablation, my heart responds very quickly and hits higher rates with minimum exertion, and my HRR (heart rate recovery) is significantly decreased from before the ablation. While I am still in the healing period, I have noted at least one person mention this heart behavior has become their new normal and the decreased HRR (still noted after 1 year) was also mentioned in a study of the effects of ablations on athletes that I read recently.

[Buzby62]

There’s lots to learn when first diagnosed, I recommend reading up as much as you can from the AFA main website, here is a link to all the resources heartrhythmalliance.org/afa... I would start with the AF fact file. Remember that everyone has a different experience of AF and have to find our own unique treatment path.

You can also navigate that site once in there from the Menu button at the top.

I had cryoablation last December and glad that I did, I keep an update on my bio which you can see by clicking my badge.

Best wishes

[Afibbingnewbie in reply to Buzby62]

Cheers