Is this the right time for an ablation?

Hi everyone

Just joined the forum and really delighted that this is available for support.

I wanted to ask people's opinion if now is the right time for an ablation?

As background, I am 51 year old man in really good health and fairly good shape. My first afib episode was about 4 years ago and then nothing again until turning 50. Since then I have had a steady increase in episodes. Some brought on by clear triggers, others have just come on while sitting down or on a short walk. They tend to last for around 10 - 12 hours at a time and then revert to sinus rhythm.

In late January this year I was put on a 14 day heart monitor with the NHS (yeah, I live in the UK) and the results came back showing several episodes over the period with HR getting up to 150 and at times 180. I seemed to be having episodes 3 times a week. Following this, the referral for an ablation has been expedited and Im booked in to have one on the 13th April. I began taking 2 x 5mg Apixaban today :-(

So far, it makes perfect sense to have an ablation, however, since mid February, I have been closely following Dr John Day's new book 'The Afib Cure' and committed myself even further to lifestyle changes. I am almost exclusively eating a whole food, plant based diet and have one cup of coffee per day. I have also kept off alcohol. I thought i was being health before but the book has turbo charged my commitment. As a result, I have only had two episodes of afib over the last month and both brought on by strenuous exercise. Both episodes lasted around 6 hours and helped by taking a beta blocker PIP.

In light of this, do you think now is the right time for an ablation? My heart does not feel quite 'stable' if that makes any sense and i feel it could leap into af often in the day. At the same time, my episodes are more manageable more recently. I also dont want to miss out on the chance for an ablation with a great EP at a superb London hospital

Any advice? Sorry for the long read!

Thanks so much and all best health to you all

Jonathan

Which hospital and ep are you seeing, I had mine done 4 and half years ago in royal brompron

Its with Dr Julian Jarman and the Royal Brompton. Any thoughts? Thanks

Not sure, mine was with prof Sabine Ernst, great hospital though, I’m sure you’ll be in great hands

Lifestyle changes, diets and usual supplements (magnesium, d-vitamin...) are always worth a try. If they work, you're good without meds or ablation.
It seems those changes brought some help reducing your number of episodes (but do you really feel each one of them ?), but you still have afib.
Si, why not going for an ablation ?
But remember : even if you're afib and meds free after the procedure, carry on with the diet and lifestyle changes that had positive effects before.

Thanks Pompon - that is super sensible advice. Appreciated

I would absol. go get the ablation....i did things (prob. 5K or more in supliments....in 4 years and i always ate near perfect) that sometimes helped a little or a lot also but i still had from 2 to 12 a month....so it is possible to slow it down with natural intervention but nearly impossible to stop it. esp. long term as this condition only get's worse with age.
Not to mention from the neck up...when i was in NSR between ep. all i could think of was "When is the next one coming...When is the next one coming" ..... i have been free from that mental torture now for 2.5 years...it is an incred. feeling mentally....it is not just the time your in it.....it's ALL THE TIME your thinking about.
I wish i would have done mine sooner as i did exactly what your doing aka finding out if the natural way can fix this...not knocking that for you or anyone who is doing it as it helped me also but that's the key word HELPED not fixed...the Ablation fixed me not just the condition but gave me my life back MENTALLY.

Just my op. as i see a lot of you in me.

GL

Coffee? Wow huuuuge trigger for most afibbers, right? Would be an interesting trial to stop drinking it and see if your pattern changes.
Good luck
Jeff

Quote
Jeff W
Coffee? Wow huuuuge trigger for most afibbers, right?

You sure about that?

That's what doctors have been telling afib patients for decades, and afib patients have been telling each other because their doctor told them, but there's actually little or no evidence to support it. In fact, quite the opposite. Some studies have shown caffeine to be beneficial for people with afib.

Quote
vanlith
I would absol. go get the ablation....i did things (prob. 5K or more in supliments....in 4 years and i always ate near perfect) that sometimes helped a little or a lot also but i still had from 2 to 12 a month....so it is possible to slow it down with natural intervention but nearly impossible to stop it. esp. long term as this condition only get's worse with age.
Not to mention from the neck up...when i was in NSR between ep. all i could think of was "When is the next one coming...When is the next one coming" ..... i have been free from that mental torture now for 2.5 years...it is an incred. feeling mentally....it is not just the time your in it.....it's ALL THE TIME your thinking about.
I wish i would have done mine sooner as i did exactly what your doing aka finding out if the natural way can fix this...not knocking that for you or anyone who is doing it as it helped me also but that's the key word HELPED not fixed...the Ablation fixed me not just the condition but gave me my life back MENTALLY.

Just my op. as i see a lot of you in me.

GL

Thanks Vanlith. That also makes a lot of sense and is reassuring to hear

Quote
Carey

Coffee? Wow huuuuge trigger for most afibbers, right?

You sure about that?

That's what doctors have been telling afib patients for decades, and afib patients have been telling each other because their doctor told them, but there's actually little or no evidence to support it. In fact, quite the opposite. Some studies have shown caffeine to be beneficial for people with afib.

I've tried all kinds of diets. Coffee does nothing (for me).

Jonathan

Is your ablation to be done on the NHS or privately? And how long did you have to wait before it was scheduled?

Gill (also in UK)

Hi Gill

Thanks. Its been done on the NHS at the Royal Brompton. I was referred to an EP following increased afib episodes mid 2020. An ablation was a possible treatment plan but due to Covid, the waiting list was very long. However, in January this year, I had a 14 day monitor and following the results from that, they expedited it, so - to my complete surprise - they called me two weeks ago to book me in for mid April.

Where are you on your journey with this, Gill?

J

Hi Jonathon

Thank you for that information. My journey has been long!! It started many years ago, paroxysmal AF undiagnosed for many years, then finally diagnosed by chance in 1994. I tried various medications which all made me feel worse so during an episode I just used to rest and wait for it to stop.

Over several years the episodes happened more often and lasted longer, until eventually they all joined up and I had long term persistent AF, highly symptomatic, felt as though my life was over. At that time no one in UK was doing ablations so after a huge amount of research (I hadn’t discovered this forum then) and against the advice of my EP in London, I went to Bordeaux in January 2003, had an ablation then three days later a second one because AF recurred. Since then I have been in sinus rhythm - 18 years, can’t believe how lucky I am. I still hang out on this forum now and then because I like to keep up to date just in case AF should ever return.

The reason I asked about your situation is that a year ago, while being treated for something else, my husband discovered that he had persistent AF. He was completely unaware of it, and had noticed no symptoms.

He had various tests scheduled but they were all subsequently cancelled because of COVID. By August he became very ill, wouldn’t go to the doctor, and ended up in hospital with heart failure - heart rate was 180 for an unknown length of time. This has been treated and he is doing well, though on a lot of medication.

The tests have now started again - he had a CT-angiogram this week and an echocardiogram is booked for next month. He would like to go for ablation if tests show that he is a suitable candidate.

I have no idea how long the waiting list is at King’s where he is being treated, and I don’t know how expert the EPs there are. I do know that Sabine Ernst at Royal Brompton is very good but if we go the NHS route, even if we could get referred to her, we won’t know whose hands are actually on the catheters, which is the most important thing.

We are thinking of going to Bordeaux but of course travel is not allowed at present. He is currently stable, and anti-coagulated so we have time to think about what is best to do.

Sorry this got a bit long!

Gill (pronounced 'Jill' in UK and female, for Americans!)

Hi ElectroBlu. From my experiences of battling AFIB since 2006 I 100% go with the post from vanlith above, its all about getting your life back. I am sure many will have experienced thinking they have got on top of this curse only for it to reappear again for no apparent reason. As an example I booked an ablation in Bordeaux in 2007 or was it 2008 after having an ablation at Escorts hospital in new Delhi India maybe 6 months earlier which did help reduce the AFIB burden but in no way stopped it i.e. I could not do any running or gym work which was a major part of who I was and when climbing stairs I would stop at every level, just in case. On booking my appointment with Bordeaux who gave me a slot only 3 months hence instead of the expected 12 months I was over the moon knowing I was going to arguably the best hospital in the world in regards to AFIB. No sooner did I get the confirmation reply from Bordeaux than the AFIB, PACs etc, etc disappeared totally to the point that one week before setting off to Bordeaux I purposely intensely exercised myself into an AFIB episode, which in my case could last up to 48 hours, to prove to myself that I still needed to have the ablation.... this is all recorded in one of my many posts to this BB at the time.

Again, going off my experiences and the points mentioned in vanlith's post I strongly believe there is a mental side/cause to this hideous affliction which on my infrequent visits to this website these days I rarely see mentioned anymore. It is almost as if some serious afibbers actually wish an episode to start up to take away the burden of hoping that it wont start up ...if that makes sense.

To summarize take the ablation, they must be far safer these days than when I started having mine...total five...between 2007 and 2010 and certainly much safer than when Gill, pronounced Jill, had her ablation in Bordeaux around 2004ish I believe, another story :-).

P.S. I am also a Brit, from Manchester, however my AFIB battle started when I was living and working in Macau an ex - Portuguese colony just a 40minute ferry trip from Hong Kong where I now live (Hong Kong) as a permanent resident. As you can imagine travelling from the Far East to India and France for a procedure/operation is not to be taken lightly given there are no guarantees and the obvious costs involved.
NOTE: Do not let the fact that it took 5 ablations to rid me of arrhythmias discourage you as when I had my first ablation (of 4) in Bordeaux Professeur Jais, maybe the best in the world at the time said " You are possibly in the three most difficult cases I have ever come across and I have done over 4 thousand in the last 10? years, if not then certainly in the most difficult 10"

Cheers,
Barry G.

Quote
Gill
Hi Jonathon

Thank you for that information. My journey has been long!! It started many years ago, paroxysmal AF undiagnosed for many years, then finally diagnosed by chance in 1994. I tried various medications which all made me feel worse so during an episode I just used to rest and wait for it to stop.

Over several years the episodes happened more often and lasted longer, until eventually they all joined up and I had long term persistent AF, highly symptomatic, felt as though my life was over. At that time no one in UK was doing ablations so after a huge amount of research (I hadn’t discovered this forum then) and against the advice of my EP in London, I went to Bordeaux in January 2003, had an ablation then three days later a second one because AF recurred. Since then I have been in sinus rhythm - 18 years, can’t believe how lucky I am. I still hang out on this forum now and then because I like to keep up to date just in case AF should ever return.

The reason I asked about your situation is that a year ago, while being treated for something else, my husband discovered that he had persistent AF. He was completely unaware of it, and had noticed no symptoms.

He had various tests scheduled but they were all subsequently cancelled because of COVID. By August he became very ill, wouldn’t go to the doctor, and ended up in hospital with heart failure - heart rate was 180 for an unknown length of time. This has been treated and he is doing well, though on a lot of medication.

The tests have now started again - he had a CT-angiogram this week and an echocardiogram is booked for next month. He would like to go for ablation if tests show that he is a suitable candidate.

I have no idea how long the waiting list is at King’s where he is being treated, and I don’t know how expert the EPs there are. I do know that Sabine Ernst at Royal Brompton is very good but if we go the NHS route, even if we could get referred to her, we won’t know whose hands are actually on the catheters, which is the most important thing.

We are thinking of going to Bordeaux but of course travel is not allowed at present. He is currently stable, and anti-coagulated so we have time to think about what is best to do.

Sorry this got a bit long!

Gill (pronounced 'Jill' in UK and female, for Americans!)

Hi Gill, I had my ablation done by Prof Ernst at the brompton, I was part of her ganglionated plexus trial

Gill, thanks for the great post and information. It is much appreciated and that is all really useful to know.

Glad to hear your are in sinus rhythm for so long and long may it continue!
Hope your husband gets the help he needs too.

Thanks Barry, Great post and super helpful! Yes, its a strange paradoxical twist of fate that the moment one is booked in for an ablation the episodes subside. I fully take your point about the mental side of it too. In any given day, I often think and feel Im about to go into an episode and thats a lot of time and energy to spend on it. I am more at peace with the decision to go ahead. Thank you

So, I am in afib since 10.00am UK time following doing rigorous exercise. I now feel certain that an ablation will help. I really dont want to live with this impacting on my lifestyle anymore. Also, the anxiety when in afib and waiting for it to end is a unique and horrid experience. I just need to remember this when Im in sinus rhythm. During those times, I tend to forget how awful it is to be in afib!!! Dont know if anyone else can relate. Thanks all for your input previously.

We never know whether afib will start or not.
When it starts, we never know if we'll get back to NSR and, if we do, how long it'll take to.
It's stressfull, isn't it?

Even when i was asleep i would be thinking/dreaming about it and if i woke up in the middle of the night the 1st thing i would check was if i was in ARR. or not as prob. 90% of my 10 ep. or so a month happened in my sleep dev. in the 1st 3 hours or so......there was NO ESCAPE from this for me 24/7.
After the Ablation i felt and told people it was like i had a heart transplant even though my heart other then this malady was/is in A+ condition as yours seems to be also BLU.....but what good is that without this horror gone.....it's like a cadillac running perfectly but has an electrical short in the engine that pops up every few days and you can barely cripple your way back to your driveway but on the other days even when it ran famously you still had white knuckles gripping the steering wheel driving down the street and would not dare take your car any great distance cause you know what was coming...but not exactly when but soon.
That car becomes almost useless until it's fixed no matter how well it runs most of the time.
When they wheeled me into the EP lab i was singing...just like i would have been on my way for my app. at the service station for another electrical problem.
As i told someone else on this forum a few weeks ago don't focus or even think too much on how your feeling right now if your still in ARR. or not or even the next few days/weeks....think of how great it's going to be to get your life back again both body and MIND.
Of course we all know the % that work and don't but you being very healthy helps and probably increases the chance it will be a str. forward RF PV only Ablation which greatly increases your success % on the 1st try at least for a few years to forever as i am in the same uncertain but presently blissful boat as i speak 2.5 years later.
It's like your working your way towards that incred. vacation you have been waiting for very badly.....so BLU....live more in the FUTURE then in the present at this time in your life.

All the best + GL



Edited 1 time(s). Last edit at 03/25/2021 10:30PM by vanlith.

Ah, Vanlith! You are speaking my language now. Thank you SO much! I love the car analogy and totally relate to white knuckling the steering wheel. That is exactly how i felt today. Thankfully back in NSR now following a beta blocker PIP.

Really appreciate your advice to be more future-focused at this point in my life. That's quite a reframing that the ablation is a gateway to a vacation. I certainly hope that its a chance to get mind and body back again. Your message helps. Real pleased to hear about your progress and that you are doing so well too!!!



Edited 1 time(s). Last edit at 03/25/2021 10:59PM by ElectroBlu.

So, after having no episodes for a while, I now have had 2 episodes within two days! Currently in one now. While its really horrid to have this, I am clearly convinced that I need an ablation. I am tired of this impacting on my life - and just hope the ablation does its trick! Two weeks to go!