Have had many thoughts lately I am now in a sticky place here we go . I have paroxysmal arterial fribulation I do not tolerate most drugs ie bisoprolol. verapamil digoxin. I am on a split dose of a 2.5 mg tablet of bisoprolol as t hives a slightly smaller dose of this med which keeps me to a sleep bm. of about 54 and a wake average of 65 bpm a few ectopic s now and then due yo bisoprolol intolerance but no. choice I have flecainide as if needed pip but have had no. episode s for the last 6 months I am about to start testosterone replacement therapy ,this should be interesting as it can effect afib which the cardiologist nurse didn't. Know lol if this works should I bother with ablation as it seems settled for will the beast return as I am only 62 and male of course
Ablation or not: Have had many thoughts... - Atrial Fibrillati...
Ablation or not
Hi Aprilla.
To ablate or not to ablate? Sorry to say but it's likely your Afib will return at some point. The decision to have an ablation or not is only a decision you and your medic can make. You could be a candidate for Pulse Field Ablation - that would be my go-to. Discuss it with your medic as I can't answer if it would be suitable for you or not.
Paul
Thanks my cardio and cardiac nurse have tod me to think about what quality of life expect and have left the decision to me
OK, Aprilla.
Use the search box at the top of the page (it appears to have disappeared at the time of posting this. I'm sure it will be back).
OR
Contact Tracy at Afib support - I'll bet she can give you more information to help with your decision.
Paul
Patient Helpline: +44 (0) 1789 867502
Email: info@afa-international.org
Thx will do
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Kind regards
TracyAdmin
What is the best way to contact you guys
Hi Aprilla.
It's not me you will contact but the HealthUnlocked admin. You can get in touch with them using the details above - Monday to Friday.
Paul
I’d just wait a bit. See how the testosterone therapy goes.
Me too a bit nervous
Treatment for AF is about finding what works best to provide quality of life for you. For me, that's currently medication. If/when it no longer provides my desired quality of life I will go for ablation. Until then I doubt ablation would provide enough improvement in my QoL to go through what could be a traumatic experience with no guarantee of success.Don't get me wrong though, ablation also has the potential for longlasting relief from AF and it might be a straightforward procedure with quick recovery. However my AF is low burden, so I'm not expecting ablation to make a major difference to my QoL. So for me I'll wait until it might.
I just read this. I subscribe to Medscape (free) . I doesn’t address your dilemma directly but is an interesting reminder that there are no easy answers.
Symptomatic vs Asymptomatic AF
The European Heart Journal (EHJ) has published an extensive meta-analysis of studies looking at the association between symptom status and clinical outcomes in patients with AF.
It’s a historical thing, symptomatic vs asymptomatic AF, but the era of digital health is changing things in AF care. Not well known is that nearly half of patients with AF have no symptoms.
The analysis, from a team in Northern Greece, first author, Dr. Paschalis Karakasis, found 36 studies with over 200,000 individuals. Of these 36 studies, five were randomized controlled trials (RCTs).
Outcomes studied were mortality, CV death, stroke, hospitalization, heart failure (HF), and AF progression.
There were some interesting findings:
For all-cause mortality, 21 studies involving 176,000 patients, the authors found no difference between symptomatic and asymptomatic AF.
Same with CV death; in15 studies and 38,000 pts, there was no difference in CV death between the types of AF.
Same with stroke, 19 studies and 120 patients, the hazard ratio (HR) was near 1 for symptomatic and asymptomatic AF.
No difference also with hospitalization, though the confidence intervals (CI) were wider.
The big differences were that new onset heart failure was 33% higher with symptomatic AF.
And the outcome of AF progression was 30% lower with symptomatic AF, though this association did not hold up in a second analysis using Bayesian analysis. The point estimates were similar, and the different statistical methods are beyond my level.
Comments. That last point makes sense: if you have symptoms from AF, doctors are more likely to intervene to stop AF progression.
The authors write, and I did not know this, that the most recent European Society of Cardiology AF guidelines say that asymptomatic AF is independently associated with increased risk of stroke and mortality compared with symptomatic AF. This study does not seem to find that, and the authors suggest that AF stroke prevention should be less influenced by symptoms and more so by patient-specific factors, such as the CHADSVASC.
I agree with this, but the authors write strongly in support of rhythm control strategies, citing EARLY AF, and EAST AF, and a recent meta-analysis in JACC EP all of which find benefits of early rhythm control. But I would push back on their highly favorable view of early rhythm control.
Their data doesn’t really support comments on the value of rhythm control. It simply suggests that patients with and without symptoms have similar outcomes.
I highlight this study because modernity is changing the ratio of symptomatic to asymptomatic patients with AF.
Here is a frequent occurrence: a person who feels well — notably not a patient yet — buys a smart watch, which then tells him or her that there is AF, say low burden AF.
The watch documents that, indeed, they have AF. The patient felt well — note the past tense. Knowledge of the AF now makes the patient feel unwell.
Proponents of AF screening might say this is a good thing, and I would agree if two conditions are present: long duration of AF and high stroke risk. In this case, it is likely that initiation of oral anticoagulation may be beneficial, though you would be correct in citing all the negative screening studies such as LOOP, and NOAH.
But many of these patients with previously asymptomatic AF, made symptomatic by knowledge of the AF, are low stroke risk and low burden AF. These patients are at risk of being over-treated by well-meaning doctors.
The authors write that AF progression rates are unacceptably high, considering that persistent forms of AF are associated with worse outcomes, but I am not sure what AF progression rate they would be happy with, since the number one cause of AF is aging.
This meta-analysis finds that there is little difference in outcomes based on symptoms, which I would use as a reassuring factor with patients.
AF as a condition is changing. Gone are the days where most AF was diagnosed on 12-lead ECGs done because of symptoms. Increasingly, we will find AF early. Whether this is a good thing remains to be seen, because a) we know from ARTESIA and NOAH, that short duration AF surely confers a lower stroke risk, and b) many of these patients do not progress and may receive potentially risky rhythm control strategies, such as drugs and ablation.
One final comment. Whenever I speak about over-treatment of AF, which is prominent in profit-driven health systems, I also want to recognize that there is also under-treatment of AF as well. People often tell me of patients with AF that don’t get to see EP docs, who could have stopped the progression of AF. I get that.
The care of patients with AF is tough because it is such a diverse condition, ranging from not a problem at all to life-threatening. But that is why I like it; you have to be a good clinician, a robot with AI can’t do it.
A lot of interesting points will investigate thanks
Thank you for that thoughtful summary of a complex study. I am assuming that the populations who were the subject of these studies whether symptomatic or asymptomatic were known by health services to have Afib and therefore were likely to be, or have been, assessed for treatments. This might explain why broadly health outcomes are similar - though hard to explain the independent association of asymptomatic Afib and stroke morbidity compared with symptomatic. In terms of new onset heart failure I would wonder if what perhaps tends to particularly distinguish symptomatic Afib is very high heart rates and it's that which is the biggest risk to eventually leading to heart failure. Finally in terms of lower progression of symptomatic Afib this might be because people who are symptomatic and their Drs may be more motivated to opt for earlier rhythm control treatments . Thanks again.
Thanks for posting. The only thing I’d like to add is that most people posting here are already diagnosed. The asymptomatic people can often remain undiagnosed and it’s only if when they suffer from a serious consequence that AF is discovered. Had it been identified earlier they may have had medication to manage their AF risks regardless of whether they feel it or not.
I have other conditions that are asymptomatic, one being haemochromatosis. It was discovered unexpectedly and it still has to be managed in order to prevent the potentially serious effects of iron deposition in the organs. My dad wasn’t diagnosed but he died prematurely because of it. It’s not the same as AF but in either condition, it’s better to be diagnosed and monitored/managed for better outcomes whether symptomatic or not.
Hi Autumn.
The asymptomatic people can often remain undiagnosed and it’s only when they suffer from a serious consequence that AF is discovered.
Frightening stuff! They are walking time bombs for a stroke. I read somewhere that 33% of people with AFib don't know they have it. More awareness is needed. Why don't GP surgeries promote checking your pulse? They could do this by displaying 'check your pulse' on their boards in the waiting room. Better still, the doctor could do it for every patient they see—it would only take 30 seconds.
Paul
Yes, it’s a scary thought. There was a trial where pharmacies checked for AF using a Kardia which picked many asymptomatic cases. There was talk of it being rolled out but I’ve not heard anything more about it. It’s a good idea.
Hi Autummn.
It certainly is a very good idea. It's the same old story though - talk the talk but not walking the walk!!!
Hey, why don't we all suggest to our local pharmacy that THEY pay for a Kardia to help save lives? These guy's rake it in and can afford it. Your post has given me another idea 
Paul
Yes, I suppose they could. It could certainly be part of the NHS health check.
hi, I had an ablation 4 months after I went into permanent AF. The very wise experienced consultant, at London Bridge private hospital, was very honest, which I greatly appreciated. I had two failed Cardioversions and wanted a permanent solution, if possible, rather than continuing on the meds. He said if I did nothing, my heart would become “saggy”. The chance of a successful ablation for me would be 70% if I had it asap, but he could not guarantee that I would feel better.
So, the cryoablation worked and I’ve been in sinus rhythm for 2.5 years. Post op, my local cardiologist was reluctant to let me off Bisoprolol, so after 18 months ( I had been lightheaded etc for over a year, I changed cardiologist and he let me off Bisop and I feel so much better. Shame it took so long to get off it, I also came off Apixaban and now only take Ramipril and that’s just 1.25mg, every few days….now been two weeks off that, getting there……
hi Aprilla, the choice is yours.! Iv had three ablations but still get episodes of AFIB now and again and still get ectopics unfortunately. But I’m still able to work full time and do the stuff I like doing and I’m sure I’d be in a different position now if I’d chosen not to have the ablations.? AFIB is mongrel of a condition and everyone is affected in many different ways but I would ask your electrophysiologist what he/ she advises.? They’re the experts and they know. I wish you well with whatever you choose to do.👍
All the best mate
Ron
.I am about to start testosterone replacement therapy
Don’t know about relation to afib, but would be good to coordinate with a urologist if you have not to insure therapy will not increase risk of prostate cancer.
Aprilla12345
Amioderone or not?
recurring problem to ablate or not
Beta blockers post ablation 
Ablation or Not?
Post Ablation exercise!! 
