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At what threshold of AFib would you consider getting an ablation?
For about 12 years I'd been going into afib, I'd either get cardioverted or drugs which would take me back into a normal rhythm for a couple/few years. (oddly consistant that I'd go afib, get taken out of it then be perfectly fine for 2 or 3 years almost to the same week) Then over the last 3 years it's been popping up more frequently, every 8 months or so but generally only lasting hours or a day. (I've been under the care of a cardiologist since the first event). However, my last event trying drugs to get me back in rhythm lasted a couple of months, eventually I was cardioverted earlier this year and I'm back to normal again (7 months). This time I've been taking Multaq since the cardioversion. I occasionally feel a little "something" but never enough to stop me from light hiking/golfing/mountain biking.
My cardiologist sent me to meet Dr Marcus Wharton for an ablation and we've set a tenative date. Here's my uncertainty. My cardiologist thinks ablation is a good idea, Wharton thinks I'm a good candidate for it. I got a second opinion from another cardiologist who was much more on the fence thinking that my episodes are under control so far and didn't think the risk of surgery was worth it. I'm a type 1 diabetic and my endo of 10+ years (who admittedly is not a cardiologist) and I spoke about it and he also wasn't convinced that the risks (however small) were worth it given my history.
Since everyone here is to varios degrees some personal experience with it, I'm curious. If you were going to get an ablation what is the minimum threshold of issues that would have you take that step. For example if you've been in afib once 20 years ago after a night of binge drinking you probalby don't have a serious enough of a condition to consider an ablation. Where is your line for frequency/intensity of the condition before you'd consider surgery?
retiredlcsw, August 20, 2019 1:57pm EST
I had an ablation done over 2 years ago after having only 5 or 6 episodes of paroxsymal afib that were of a very short duration ( under 5 hours) in a period of only serveral months.. Each time I had an episode I went to the ER - the first time I went back into NSR in about an hour on a Cardiazem IV drip. The second time, I went I had a cadioversion. The other times I converted back myself before they could give me any medication. I was 69 yo at the time and had no other health issues, so the cardiologist referred me to an EP who recommended ablation. He felt that I would have a successful outcome due to the recent start of a-fib and no other health issues, and my age. I had a loop recorder inserted and had the ablation done and was so thankful that I did. I have had no episodes since, am no longer on a bloodthinner, and take only 1 Diltiazem XR daily as a precautionary measure. I had a lot of anxiety prior to the ablation, always worrying that an episode would start up. And they always seemed to happen in the middle of the night or very early AM hours. I live alone, and it was a drag calling friends to take me to the ER in the middle of the night!!! So my recommendatioin for you would be to seriously consider the ablation. It was not difficult, has very little recovery time afterwards, and can alleviate a lot of anxiety for you in the future. Best of luck!!!
john1818, August 20, 2019 2:13pm EST
From everything I have read and my personal opinion, a key factor should be your quality of life. I average 9 episodes a month that last a day or two. I prefer to deal with the episodes. Until it becomes unbearable, or life threatening, I’m not ready to take the risk of any surgery. My cardiologist has suggested an ablation, an EP says I'll know when I'm ready.
I read this blog and know that it may take more than one ablation. While the success rates are pretty high, I would like better odds.
Patio7, August 20, 2019 7:40pm EST
Dear Raked, I began having aflutter and afib in October 2017. Often lasting days. First event the decision was not to cardiovert as we were unsure as to when it began and thus fear of bloodclot. Started eliquis and rate meds, three weeks of in and out...a planned cardioversion was aborted when flecainide was begun and NSR was restored. The next four months with lots of rate meds and flecainide I was in afib more than out. I never went to ER again but monitored at home. Was told so long as I was in no pain, I could monitor at home. Finally when I could not convert after a long persistent aflutter with HR at 165+ the choice was ablation or try a stronger rhythm med ( dofetilide) which is adminstered in the hospital to see how you tolerate. My quality of life was zero. I would have done ablation with risks and not great odds, but am happy I opted for dofetilide first. Worked like a charm. No more rate meds, no ablation risks or recovery. Eighteen months out and I am once again traveling a bit, and playing golf, gardening, and 🤞 no events. My doctor has patients on this for over 10+ years and counting.
My measure is what is my quality of life and what are the risks. At my age (79) and a slight female, the chances of a single ablation working on atypical aflutter and afib aren’t great, and recovery is a bigger percentage of my likely quality years. I think everyone has to do the cost/benefit ratio analysis for themselves. If you make an honest evaluation you will be able to handle almost any outcome.
You are asking the right questions right now. Congratulations. You will do just fine👍. Pat
Leilani, September 1, 2019 9:29am EST
Dr Wharton is my dr as well! Also considering an ablation. Dr W is an absolutely wonderful doctor...have a couple and he is the most knowledgeable, by far, the best in his field. Look forward to my appts with him as he has in depth understanding of afib and leave with all my questions answered before I can ask him. He takes the time to make sure we have actually had a conversation....Addtionally, he has a great warmth and kindness to his patients that is just extraordinary.
Thumper2, September 2, 2019 8:29am EST
I feel like a broken record on this topic, but make sure, if your AFIb is "tolerable," that your heart is not slowly remodeling itself (e.g., valves regurgitating, etc.) to the place where ablations will no longer help and you are left chronically out of energy. BTW, ablations are "procedures," not surgery, and do not involve much recovery time. Keep us posted!
Raked, September 3, 2019 11:01pm EST
Thanks everyone for your input.