Raked
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Raked, August 20,  2019  1:33pm EST

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
    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
    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
    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
    Leilani, September 1,  2019  9:29am EST

    Hello,

     

    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
    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!

    Thumper2 (Judy)

  • Raked
    Raked, September 3,  2019  11:01pm EST

    Thanks everyone for your input.

  • retiredlcsw
    retiredlcsw, September 19,  2019  2:12pm EST

    Ike,

    It is wonderful that your team is looking to bring new therapies to the a-fib community.  Not sure how much help I can be, since I had my ablation done in April 2017 and had a Medtronic LINQ loop recorder inserted one month prior to my ablation. This is monitored remotely by my EP, and since my ablation, I have had no further episodes of a-fib. The battery will run out on my recorder in about 6 months and I will elect to have the old one removed and a new one inserted.  I like having the security of having someone monitor me regularly- even though my a-fib episodes in the past were always quite evident to me- rapid heartbeat and very irregular heart beat that felt like a "fish flopping around" in my chest.  Would even make my shirt move when I was having an episode.

    Not sure if I can help- but  you can contact me via this site if needed.

    Barbara

  • ichinyere
    ichinyere, September 19,  2019  3:25pm EST

    Hello Barbara,

     

    Thank you for your feedback, it is truly appreciated. You certainly were a help, and I would love to ask you a few more questions if I may? I am fine with continuing the conversation on this forum or you can send me an email (ichinyere@email.arizona.edu)

     

    Thank you again and looking forward to connecting

     

    Ike

  • retiredlcsw
    retiredlcsw, September 22,  2019  3:26pm EST

    Ike,

    I will contact you at the e-mail address you provided.

    Thanks,

    Barbara

  • ichinyere
    ichinyere, September 26,  2019  2:43pm EST

    Good afternoon Barbara,

     

          Just following up to see if you are still avaialble for a few questions via email?

     

    Looking forward to connecting

     

    Thank you

     

    Ike

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