rate control of AF - what are the consequences?

I am a 60 year old male and have a normal BMI. Paroxysmal AF (vagally mediated) started approx. 2 years ago. I have been in AF continuously for the past 6 months. I am moderately symptomatic.
I have had two cardioversions, both on amiodarone (200mg). In the most recent I converted on the third attempt but reverted back to AF after a few minutes.
Echo study showed that I have mild bi-atrial dilation and mild mitral and tricuspid regurgitation. Ventricular structure and function are normal.
I am now considering catheter ablation and ideally would like to establish the chance of success and weigh this up against the option of remaining on rate control.
Currently 5 mg bisoprolol is controlling my pulse rate at below 90 bpm.
I understand that with rate control it is only the ventricular rate that is controlled and the atria continue to fibrillate at a very rapid rate. I have been unable to find relevant studies to establish what would likely happen in the long term (5-10 years) if I rely solely on rate control.
Can anyone please answer the following:
Is it inevitable that adverse structural remodelling will occur and if so over what timescale?
Will the risk of stroke, dementia, and heart failure likely increase with time while continuously in AF when the ventricular rate is adequately controlled?
…..
Many thanks for all the very helpful replies so far.
In reply to some specific questions raised:
I am on apixaban 5mg bd
My average resting HR is 76 bpm

I



Edited 1 time(s). Last edit at 08/27/2018 08:33AM by kpa.

Heart failure, no. That is exactly what rate control prevents.

As for stroke and dementia, that is anticoagulation. Are you taking an anticoagulant? If so, which one and what dosing?

I was 66 yrs young in July of 2015 when my lone fib was diagnosed and it was persistent. The local cardiologist prescribed Xarelto and amiodarone; I said yes to the Xarelto but NO to the amiodarone. My wife and I went home and immediately began searching for the best EP; needless to say that road lead straight to Austin, Texas Cardiac Arrhythmia Institute and Dr. Andrea Natale. I had an ablation in October of 2015 with no problems and excellent result---blissful normal sinus rhythm. Dr. Natale had predicted that a touch up ablation may become necessary (because my afib had been persistent) and sure enough while on vacation in Oct. of 2016 I developed afib with rapid ventricular response. I went back to Austin and Dr. Natale did the touch up ablation and I've been in trouble free NSR ever since. A few weeks ago I returned to Austin for left atrial appendage closure (Watchman). In a few short months I will be able to get off the Xarelto.

I am very happy that I made the decision early on that I did not want to stay in afib. I am so grateful for the truly world class health care I have received. My wife and I are retired now and looking forward to enjoying decades of active, healthy, happy living.

This forum has been such a help to me (thank you so much Shannon!). I wish you the very best as you decide how you want to deal with this.

Jerry



Edited 1 time(s). Last edit at 08/26/2018 03:54PM by jsmith1015.

Quote
kpa

Is it inevitable that adverse structural remodelling will occur and if so over what timescale?
Will the risk of stroke, dementia, and heart failure likely increase with time while continuously in AF when the ventricular rate is adequately controlled?

If you're in persistent , remodelling is more than likely. The biatrial enlargement, etc, is already happening, even with medication. If cardioversion isn't working at all, most likely your case is complex. There's a window of opportunity for a successful ablation, the sooner the better.



Edited 1 time(s). Last edit at 08/26/2018 04:16PM by jpeters.

Is it inevitable that adverse structural remodelling will occur and if so over what timescale?
Will the risk of stroke, dementia, and heart failure likely increase with time while continuously in AF when the ventricular rate is adequately controlled?

You've already had some remodeling, although if the Rate Control is low enough, you shouldn't worry about Heart Failure.
The longer your in AFIB, reduces the chances of successful Ablation. Dr Natale has had success with long-standing complex cases like yours. The risk of Stroke would increase as it would for anyone as they get older. I have never heard that your Stroke risk is higher 3 months into AFIB, vs only 1 month. Although obviously cumulatively the risk of Stroke goes up the longer you are in AFIB. Maybe you could try another Anti-Arythmic Drug, but it is not a good sign, if when Cardioverted, you go right back into AFIB. What is your average HR? Your symptoms should decrease corresponding to your Heart Rate.

Having said all of this, Ablation (by an Expert) would seem to make sense, since you are somewhat symptomatic.

I am interested in knowing whether you live near Austin and how you got to Dr Natale for care
I am looking for an ablastionist for my lone a fib