Ablation or not

Hi all, new here and am glad there's such a community. I'm 34M have had 4 episodes of Afib since I was 27. 2 episodes at 27 assuming stress related and I was in bad shape, vaped, drank, 350 lbs. Fast forward to 34 dipping 305 had another one high heart rate, been on metoprolol since feelin meh but have changed my lifestyle around. Down to 250 at 6'3 and plan on continuing. No one's really sure my cause outside of weight and I have a sleep study in a month to see if I have apnea as I've always been laying down when it happens and typically wake up in Afib. So question is my Dr's here in TN at Vanderbilt seem to be against ablation at this point have me on the metoprolol 12.5 twice daily and flecainide 50mg twice daily. Also taking Buspar 5mg twice daily for anxiety from all this and just really done know if ablation for sure or listen to these EPs that know more than me and keep losing weight and taking these meds that don't totally wipe me out but definitely don't feel myself but idk if that's the meds or my anxiety tbh. And with my episodes so far apart do I risk an ablation making it all worse or I DONT KNOW ha. Just looking for opinions. The Dr's don't seem to want to ablate yet but I know the earlier the better supposedly but then how many ablation would I need in my life if I get one at 34 idk. Help pls ha.

If I were in your position, I'd hold off on an ablation until -- at least -- the results of your sleep study are in:

Worth a quick read: [www.mhs.net]

Some AF patients have most of their AF, or all of it, when they recline or go to bed. It's positional, obviously, but it might have something to do with adiposity or other factors, even the rare instances of cardiac situs inversus.

AF is usually, not always, due to extra electrical impulses issuing from the ostia of the pulmonary veins, of which there are four at the high posterior surface of the left atrium. Many cases of AF are ablated, finally, and the method is to scarify the endothelium inside and just outside of the pulmonary veins, whether the ostia or antrum. Other cases require ablation of the coronary sinus, or the Left Atrial Appendage (LAA), and even the Vein of Marshal and septum itself. So, the skilled and conscientious EP will perform a mapping function as he/she does the burns with the radio frequency needle to make sure the lesions are being located properly and so that they ultimately restore normal sinus rhythm (NSR).

You should enquire as to why you don't appear to be a candidate, at all or just for now, according to your cardiologist or EP. You are right to want an ablation sooner rather than when it's going to be a lot tougher to ablate, especially by anyone within a day's drive for you.

My reasoning is that no patient should have more drugs in him/her than is absolutely critical for survival or for repair. You are on anti-anxiety pills, maybe also SSRI (?), and on a beta-blocker, and hopefully also a DOAC (Direct Oral Anti-Coagulant....like rivaroxaban or apixaban). You could be rid of those in short order if an ablation succeeds and NSR is restored for you. So, I would want a strongly reasoned, evidence-based, prognosis for you based on whichever conditions are to be considered ethically and scientifically, and then which lead to a reasoned explanation why you should NOT BE ablated.

My 2 cents.

No blood thinner at the moment or anticoagulant as they said my chadsvasc is 0. They never said I wasn't a candidate just that they don't want to go in for a surgery before trying lifestyle change and sleep study saying obesity and apnea are the two highest causes of afib. Stating just because a surgery is low risk doesn't mean no risk. Idk also met with a research EP to study my genetics and he didn't even blink when I asked about an ablation saying he'd schedule me in a few months so just mixed signals I guess

I agree with NBeener. Wait until the sleep study is complete. You're young, you're headed in the right direction health-wise, so you've got plenty of time to figure it out and get it right. Ablation is considered the first line treatment for afib now, but there's no rush. Once you decide that is the way to go, then you can spend some time making sure you've got the best EP for the job that you can get. Vanderbilt has a couple of very good EPs, but they're not the best you can get.