I wanted to pick the forum's brains regarding Ablation or Medication. I'm sure people will have different views, but I want to try and get an understanding of where I am in my AF journey. I'm currently under a Consultant Cardiologist who when I had my initial appointment placed me on Amiodarone. My medication has been reduced and other than the odd slip back into AF I appear to be responding to it well. I'm aware of the possible side effects with this drug and have highlighted this to my Doctor. He is of the opinion that the meds work OK and the dosage I'm on "Shouldn't" cause me any problems. However, I have been advised to have 6 monthly Thyroid checks. In the short term I have had no side effects and feel great. I'm in NSR and as active and busy as I was before AF. I did have one slip up a while ago and the Doc suggested I up the meds for a short while to see if that would sort me out. It did, but he did stress if it didn't I would be in for a Cardio Version. I asked about an ablation, more I wanted to get an understanding. He is of the opinion that me being healthy and responding to medication an Ablation isn't without risks and is not my best option. I believe there is nothing more he can do and I've booked an appointment with my GP to discuss the past few months and discuss my future medication. I am going to request an appointment with an EP, as I have learnt these guys are the specialists. I'm 41 and fit, healthy and active. The medication is working for me, so should I consider an ablation and would I be considered for an ablation?
Any thoughts would be appreciated.
Jason
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Jason1971
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Fist off, You're asking these questions in the right place. And you have some very valid questions.
OK... About your Meds... You are right in saying that Amiodarone is a dangerous med. Even in small doses it has been proven to have some really bad long term side effects. Which should be obvious by the Dr wanting 6 month thyroid checks. It is probably the best of the AF meds with the highest success rates But again has the highest amount of the bad side effects also. There are many other Rhythm Control meds that may work for you just as well without as many of the side effects. All of the meds for AF have some undesirable side effects, and since AF doesn't just "Go Away" it is a lifetime of meds.
Now about the Cardiologists statements... "an ablation isn't without risks and is not my best option". I could not disagree with this statement more! To put you on a med that is known to have very bad side effects that can kill a person and tell you that an ablation is risky? Yes there are risks with the ablation, as with any procedure, but they are considered minor.
It is a very good idea to get the appt with an EP. Yes they are the experts with this condition.
The longer you have AF, the worse it gets and will happen more often. There are no meds that will "CURE" AF. AF can only be stopped with one of the procedures available. Also, the longer you wait the less chance that one of the procedures can "cure" AF. If caught early, the ablation has a high success rate at stopping AF. AND... If it does not completely stop AF it normally will decrease the effects to an almost un-noticeable amount. Also If it did not work, You can always take the meds... BUT why take them when there is a procedure that might cure you?
There are many here, Including myself, that would tell you all about ablations and how they wish they had done it earlier. I suffered for almost 13 years with AF, trying to control it with meds before deciding on the ablation. I had mine done 6 weeks ago and for now am AF free. My attacks prior to the ablation were quite violent, lasted 6 to 8 hours and were happening 1 or 2 times a week. I had a couple of attacks in the first few weeks after the ablation (which is normal) and were so mild that I almost didn't realize they were happening.
As I have told many others about an ablation... You just go to sleep and when you wake up, it's all over. Normally there is little to no pain afterwards (other than being sore from being on your back for so long) with the exception of minor aches and pains. If it were required I would choose to do it again with no fears. I was quite afraid to have this done and now know that it was nothing to fear.
About the different views from this forum, I think you will hear this same story from most here.
There are many site available that explain and discuss the ablation. One really good place to get information is:
I attended the last two Atrial Fib Assoc Patients days, November '12 in London and Heart Rhythm conference September '12 in Birmingham. I found them extremely informative and there were many Cardiologists and EP's in attendance who gave great presentations. There was also opportunities to ask questions of them and break out groups on many different aspects of AF including ablation v meds, exercise, anticoagulation etc, I would strongly recommend attending in 2013.
Information is power and where else will you get so much expertise under one roof ! Everyone was really approachable and I got lots of advice and comfort.
Like you, my personal debate at the time was meds v ablation. I was afraid I might miss the boat re ablation (my AF experience is similar to yours but I am older than you. My consultant is a cardiologist not an EP).
One EP at the Patients Day said, given the personal history I was giving him, I had a good window of time to stay on meds and not miss the ablation boat.
Another EP specialist said, given my story I should look at my personal AF triggers ie my acid reflux and have that potential trigger treated first before potentially embarking on an AF ablation route. His words were "like marriage, ablation is not to be entered into lightly"
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My point to you therefore is, research, ask questions and seek as much professional input as you can. Does your hospital have an AF support group where you can get further info.
We are all unique and our AF journey should be unique to us be that straight to ablation or a meds route first and potentially ongoing. I am sure you will be guided through sound research and questioning to make the best decision for you.
Really interested in your comment about attending A.F.Assoc patient days. I live in Berkshire and am having an ablation at the Royal Brompton Hosp.in London or possibly Harefield Hosp. in Middlesex.in approx 4 months time.I would be really keen to go to one of these conferences and was wondering if you have any information regards dates and locations for 2013 ? I would also be interested if anybody had any info. about the procedure at either of the above hospitals including as you suggested,support groups.Knowledge is power and I've learnt so much from this site .
There is a Heart Rhythm conference 20 - 23rd October '13 at the ICC Birmingham same as last year. I assume they will be having a Patients day again this year as it was so successful last year. Click on the HRC conference 2013 logo shown on the AFA website (right hand column of the page) to see an overview.
The AFA advertise patients days well in advance so you can book yourself in.
Thanks for info.Hopefully I will have had the ablation by then.I would have liked to attend a conference earlier but might still go in October.All info.is helpful after all if I understand correctly this is a lifelong condition even after ablation .
I agree with Tim although I needed three ablations before it sorted me out. That was four years ago. If necessary and they offered it I would do it all again. The risks they talk about are more to protect then for law suits in my view whilst the drug side affects are real and dangerous. IN UK amiodarone is a last resort drug for most intelligent cardiologists or EPs because of this.
There is also evidence that earl;y intervention by RF or cryo pulmonary vein isolation (ablation) has the best chance of success.
Million Dollar Question and very interestingly I too have had the dilemma and will tell you what I was told by both My Cardiologist and EP.
Basically both sing from the same hymn book which is reassuring. The most important factor is that it is very much a symptom driven decision.If medication is controlling it very well and you tolerate the drugs then leave well alone. If it isn't then you have no option other than ablation.Between the three of us we decided the best course of action was to continue with my medication while ever it was controlling my Paroxysmal AF. I was quoted a 70% success rate with ablation with a ratio if 1 in 3 that require a second op..I went privately so there were no cost savings etc involved.
I too am in this boat. Recently diagnosed and on 2.5mgs bisoporlol and warfarin and respondind well to meds. Have had a couple of afib episodes in last month but fairly mild. After reading, taking note of member's experience I have decided that if its available to me I am going for ablation. My gp supports this decision and has referred me back to cardiologist I am seeing him in may. I mentioned previously that
I mentioned previously that I have been asked to participate in a study being carried out to look at this question - St thomas' in London is part of it. They want people newly diagnosed who have had little/no meds. I declined as I would have no choice which route to take - half will go on meds and half will have ablation. The thinking is that the earlier ablation is done the more successful it is but theory not fully backed by studies. My own opinion is that the evidence is strong - hence my ablation decision. Good luck with yours. Marie
I always think it is a good idea to have more than one opinion from a cardiologist who is using both medication and ablation to control AF. My own experience is that the medication did not work and after a fight to get the ablation (they were reluctant to do it because I had controlled hypertension and was over 65 (68yrs). They did eventually give in and I had ablation. The first did not work and I felt really ill for 2 weeks, then I had the second some 18 months ago and that has been highly successful. My understanding is that 50% of patients relapse back into AF over a period of 5 years. My conclusion is that because you are so young it may be best to stay on medication a bit longer. Use of ablation is relatively new and statistics do not as yet show it to have any long term benefit apart from the patient being taken off medication. On the other hand following my ablation I was put on permanent warfrin. A lot to take iin and decisions to be made. If you can trust your cardiologist then I would always go with their decision. Best of luck Beano
Thank you all so much for sharing your experiences and your knowledge on this subject. Hopefully I will get an appointment with an EP and discuss my options in further detail. If I'm honest I'm not bothered either way. The meds are obviously a worry and I would feel more at ease if I was on something a little less potent, but if I'm monitored closely and don't have any side effects, then I would be happy to carry on. If there is a chance of an ablation, I would be happy to pursue this. I don't know what my chances would be of an ablation anytime soon, as I am pretty much asymptomatic, fit, healthy and fully aware there are people who are not as fortunate and would benefit more than me at this moment in time.
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