Hi,
I have had PAF for 3 years, I take 2.5mg Bisoprolol daily and have 50mg Flecanide as PIP. I have approximately 3/4 incidents annually lasting typically 8 hours. I recently got a call from Barts Hospital London about an ablations, I didn’t realise I was on a waiting list and turned it down, now wondering if I did the right thing ?
Any thoughts gratefully received
If it were me I would be calling them back asap and saying sorry but I wasn't prepared for the call and gave an ill-considered answer and would like to go back on the list. If you were on the list they probably had a reason!
It may help to clarify your thinking if you could verbalise your thinking as to why you turned the offer down?
What is your reasoning? Or was it fear of Unkown?
Only you can decide whether you should have stayed on it. Other people will express their opinions but they are biased by their own experiences... not by yours. What worked for them might not work for you. What failed for them might not fail for you. Your quality of life without ablation might be totally different to theirs and so on.....
My experience:
I was diagnosed with paroxysmal 5 years ago and after a number of tests was put on metoprolol and flecainide. I've had several episodes a year since but generally lower in the past year or 2 and I've trialled lower dose of flecainide but reverted back to my prescribed dose of 150mg BD after several weeks. My episodes vary in duration but are only measured in hours (some in minutes) but never in days. Episodes have little impact on my ability to continue doing whatever I was doing. I therefore consider my AF to be low burden.
I've thought about ablation but I'm apprehensive about the procedure and the recovery period. Is it a case of 1 step backwards to take 2 steps forward? I can't see how my quality of life will be significantly better if my ablation was successful. Yes, there's a chance it might provide long term relief from AF but my quality of life is not significantly impacted by my AF episodes. An echocardiogram/stress test earlier this year showed no signs of deterioration or remodelling and still showed a high tolerance for exercise. There's no guarantee of success with ablation and even less chance for it to be an enduring success. So do I roll the dice and risk my current quality of life for something that might be better - but won't be significantly better. Unless/until ablation provides a more attractive risk/reward proposition I'll keep doing what I'm doing. I'm a realist though, I understand the risk/reward proposition will probably improve when my quality of life deteriorates and that might be associated with a lower chance of success.
What's the chance of an ablation significantly improving your quality of life?
If you’ve been so little concerned by your AF that you didn’t even realise you were on a waiting list I’d let someone else have your slot, especially as awareness is improving your self care!
I think my situation and opinion similar to bean counter . I’ve been on flecainide and metoprolol since nov 2022 and after a couple months of stabilizing I now experience only 1 afib episode a year. If it got worse I would probably consider ablation. I like having another option available and for now have found the meds manageable. Another consideration for me was age.., I’m 73 but pretty healthy, if I were much younger I might not want to be on the drugs for the rest of my life and would probably go for ablation. My brother about 10 years younger immediately had ablation after diagnosis and has done well .
There must have been a conversation at some point about agreeing to an ablation?As far as I know one is not put on a waiting list until a discussion has taken place?
Perhaps call back and find out more information 🤔 but tbh I dithered for several years, aided by the covid pandemic, no reason to as it turned out!
I would get yourself back on the ablation waiting list and make an early appointment with your cardiologist to consider taking Flecainide daily 50mgsx2 to stop those episodes completely.
Reasoning: Assuming you have Lone PAF with no comorbiodities and tolerate Flecainide, 100mgs is a low dose and if successful will give you a few years AF free all the while ablation procedure options and success ratings are increasing. If that doesn't work then the ablation decision is made for you.
I've had paroxysmal AF for about 10 years now. Turned down ablation when diagnosed because it seemed to me to be a barbaric approach, the AF wasn't impacting life too much and the medication seemed to be keeping it largely at bay. I hoped that over time some miracle new approach would arrive, should I ever need it.
Roll forward 10 years and after cancer treatment impacting the AF big-time, the impact on quality of life is much more. Episodes are happening much more frequently and lasting longer when they do. It's impacting both me and my husband.
There's been no new miracle cure, but a lot of development in the way that the ablation is done, which has alleviated a lot of my initial concerns. Now feels like the right time to have an ablation and I am now on the (12 month) waiting list.
As everyone says, it's a personal choice. Balance current quality of life against the other medical options.
I had an Ablation done 3 years ago when my AF went from 4 events a year to twice a month then 2 a week. I was heading to permanent AF so I was offered the Ablation. Since having done ive been AF free since Feb 2021. Im so glad I had it done when I did. Good luck
I have had PAF at least since 2020, probably longer.
2022:1
2023:4
2024: 1. Very brief episode in Feb, cardiologist didn’t like the look of the trace from my Frontier x device. Eventually identified as AF with aberrant conduction. Put on ablation waiting list. No more episodes until Nov and then had 3 in 5 weeks at around 4 am lasting a few hours. Reverted naturally or with bisoprolol and flecanide PIP. After the 3rd episode got a cancellation for an ablation and thought I’d go for it.
I am now at the beginning of week 4 post ablation and feeling pretty normal but with more ectopics and runs than usual. My plan is to do couch to 5k to get back to where I was before I had it.
So, I can’t advise. I probably would have refused if I hadn’t had the run of episodes before the call came. So you could wait and see if the episodes increase and go on the waiting list again if they do. The only thing I would add is that the evidence is increasing for early ablation having better outcomes than medication so you might want to consider that also.
Hi SantiF, I would suggest you consider talking to your cardiologist as there are more options in terms of medication. Your PiP dose of Flecainide is smaller than mine was. Another person has suggested daily Flecainide. This needs to be recommended by cardiologist and be monitored.
To make an informed choice your cardiologist needs to have spoken to you about risks and benefits of ablation.
Is your cardiology team at St Bart’s? I can see it adds complexity if one team is managing your AF and another is completing ablation.
I hope you can get the discussion you need, and make your own choice.
wonder why? So pleased I had mine
I was like you and cancelled/made an excuse and then episodes stopped me from enjoying my life and travelling, I was always waiting for the next episode. I went back on the list and waited 12 months. I had the ablation in March this year. The recovery was ok, a few ups and downs but no episodes that I am aware of since. It has given me back my confidence and freedom
I had an ablation September 2023 and I was on the waiting list for about 18 months.I sure we’ve all been worried about having it done, it’s the fear of the unknown, but if it stops the awful Afib, I think it’s worth going through with it. Paroxysmal AFib, will often become permanent after so long. The new Pulse field ablation is being done in a lot of hospitals now, so you might have that one, which is supposed to be better. I would get yourself back on the list if I was you. Good luck.
I certainly didn't contemplate an ablation until my quality of life was being significantly impaired I went from having 3 episodes a year to one every other month that lasted 4 to 5 days
I think you will know when it feels right for you .
My gut reaction is to say it's your decision. But, AFib is progressive. And it can remodel the heart. And it can lead to heart failure. Even at four episodes a year of 8 hours that's four days of not living your best life (well if your AFib was anything like mine, 180+bpm for ten hours, eventually every three days, and the three days to recover from my heart running numerous marathons). I know an EP would recommend an ablation, it's what they do. But only you can make that decision.
in my opinion, and that of one of my best friends, an experienced cardiologist (we both have AF, in a much higher frequency than yours) you absolutely did the right thing in canceling that procedure, especially if you have so few and short episodes of AF.
Ablation is an invasive procedure, causing irreparable damage to your heart. Moreover, there are considerable risks involved and a massive dose of potentially harmful radiation.
So, unless your AF burden and the ensuing loss of quality of life should become extreme, you made the perfect decision.
Don’t forget also that there are exciting new non-invasive treatments on the way, by influencing the source of AF: the vagal nerve.
All the best!
Sorry I'm not sure what you mean by radiation
The long exposure to fluoroscopy necessary to allow the EP to see what he is doing inside your heart. An average ablation is the equivalent in radiation of 100 to 200 chest X-rays
Golly gosh ,I didn't know thatI thought mine used an oesophagus ultrasound to see what he was doing
Too late now !
They usually use both.
Catheter ablation typically cannot be performed with only transesophageal echocardiography (TEE). TEE is a useful imaging tool during cardiac procedures, but it does not replace the detailed imaging and guidance provided by fluoroscopy or other advanced imaging techniques commonly used in ablation procedures.
Why TEE Alone is Insufficient
1. Lack of Catheter Navigation Guidance
• TEE provides excellent visualization of certain cardiac structures, such as the left atrium and pulmonary veins, but it cannot offer continuous and precise guidance for catheter positioning and manipulation.
• Fluoroscopy or 3D electroanatomic mapping is typically required to safely guide catheters through the heart.
2. Limited Tissue Assessment
• TEE can show structural abnormalities and evaluate blood flow but does not provide real-time electrical mapping of the heart, which is crucial for identifying the areas causing arrhythmias.
3. Challenges in Real-Time Ablation Monitoring
• While TEE can assist in detecting complications (e.g., pericardial effusion) and guiding transseptal punctures, it lacks the resolution needed to monitor catheter-tissue interaction during energy delivery.
Scenarios Where TEE is Used in Ablation
TEE is often used in conjunction with other modalities:
• Guiding Transseptal Puncture: During left atrial ablations (e.g., for atrial fibrillation), TEE helps ensure safe puncture of the atrial septum.
• Monitoring for Complications: TEE detects issues like thrombus formation or esophageal injury.
In my experience of AF (my personal issues) and of the hundreds & hundreds of emails I have read on this forum it is highly likely your af episodes will prolong over a period of time despite the medication you are on. An ablation gives you a better chance of keeping af at bay for a longer period of time. For the sake of a very short stay at the hospital I think it would be very wise to ask to go back on the list. Good luck.
If you were fortunate enough to be on a list for a procedure to correct your AF. This isn’t by chance.
Given scarcity of resources the specialists felt the procedure was right for you.
The thought of any op on the heart isn’t ideal. But a chance to be free of AF and med free. Wow, yes please!
Waiting list
I'm on the waiting list for an Ablation now
Should I have an ablation now?
Should I have a catheter ablation? 
Should I get an Ablation?
