At what point should one consider ablation?

My afib burden is pretty small compared to some (most) here. I've only had 4 documented episodes, all in the last 18 months. I'm quite sure before that I was having shorter, unrecognised episodes.

I'm getting a lot of ectopics that are making my life miserable. They come on when I lay down to sleep and in-and-of-themselves they are not a big deal but I know that if I ignore them it will trigger an afib event.

I have an appointment with my ep in 4 weeks and he's likely going to prescribe a pip approach since we discussed this at our first appointment. I'm wondering about ablation and I want to ask him about that.

I'm only 39 years old and I'm having a hard time considering a life like this where I can't go to sleep certain nights because of the ectopics.

I have tried supplements and for a year they seemed to be working great but then after my last 2 episodes, nothing I do seems to make any difference. There is always room to 'tweak' the supplements but I'm not overly optimistic about the long run.

If I went I think I would try Bordeaux, I don't hear a lot of good about the local guys here in Edmonton Canada and I can't afford to do it in the US.

Any thoughts?

Have you considered trying (gradually increasing) doses of lecithin granules, working up to 1-2 tablespoons/day, which can in some cases tend to normalize vagus function, and/or block supraventriculargenic ectopics, via the acetycholine response?

You are about the age and situation I was in when I first got AF. At the time I also tried supplements and found they didn't work that well. I was in denial, wanting to carry on life as I had been and hoping it might go away. Only much later on, after 4 ablations and a lot of reading on this site and others, did I accept that a total diet change also had to occur to keep myself in nsr.

Have you tried to identify trigger foods in your diet? Do you still drink coffee, alcohol, sugary drinks, eat any sweets, junk food, processed food etc etc?

It is sometimes hard to accept that a total change of diet, which can be a reasonably severe lifestyle change, may be the way ahead for you to stay in nsr.

If you do consider an ablation then Bordeaux is one of the best places you can go to. Cost when I last heard, which is about two years ago, was around 18k euros depending on how many days you need to stay in hospital. There is a reasonable wait, I believe it is around 12 - 16 months at this stage.

Best of luck on whatever you decide.

Montos

I had an ablation in Bordeaux 8 years ago, aged 65, after many years of paroxysmal AF and 18 months of long-term persistent AF. I was highly symptomatic and felt as though my life was over.

AF recurred after 3 days and they did an immediate touch-up. Since then I have been in nsr and feeling great. I can eat and drink what I like, exercise, scuba dive again. I got my life back.

I do get a lot of ectopics, which used to be very uncomfortable, but I take magnesium, potassium and taurine and now I hardly notice them. The docs say not to worry about them so I don't!

The money I spent on the ablations was the best money I ever spent, and my only regret is that I didn't get it done sooner. At that time the EPs in London said that ablations were experimental and dangerous and strongly advised against it. I did masses of research and had it done anyway.

The doctors in Bordeaux are superb, though of course they can't fix everyone, and when I ask about long-term results they say "You ARE the long-term. Even if AF returned tomorrow it would still have been worth it.

Gill

Sorry, last sentence should read:

"You ARE the long-term". Even if AF returned.... etc.

Gill

Montos,

I would suggest you consult with Dr. Yaariv Khaykin at Southlake Medical Center in Newmarket, ON. He has a good success rate for ablations and it would be cheaper than Bordeaux. I know the center also has the very latest in equipment.

Hans

Thanks for the input, I will try the lecithin starting tonight.

Hans and Allan, I recall a post a while back with you two discussing that cardioversion reduces your chance of a successful ablation. This from the bordeaux team. Is that for people with persistant/permanent afib or for paroxysmal as well?

I have had 2 cardioversions in the last 2 months, not because I was persistant but rather because that is the hospital's protocol. (I was only in afib about 5 hours for each). I am somewhat cautious about getting another now since remembering that. I'm still new to this so an epsiode has been sending me to the ER because it still scares the crap out of me.

After the first cardioversion all was rock solid for 3 weeks and then ectoptics and then afib. My last cardioversion was dec 11th and now again, ectopics nightly for the last 2 nights.

Maybe what I am looking for is to get my life back and perhaps that's unrealistic but right now I've given up caffeine, almost no alcohol, no late night eating, no dairy, no eggs (I fail miserably at gluten-free) and it doesn't seem to help. Actually it helped for a year but after the last two episodes, not so much.

Perhaps if (when) I have another episode I will ask for chemical conversion rather than electro. (see the ep in 4 weeks and will discuss pip)

Monty



Post Edited (01-04-11 11:10)

Monty

I don't recall a discussion with Hans about this but I did read an article on it and did discuss this with Prof Haissaguerre when I was at Bordeaux for my ablation. He said he can tell when clients have been cardioverted as it changes structures in the heart and can sometimes make the ablation harder to do.

Scary as it is, if you have no other heart or underlying health problems then going into AF will not kill you. There are people out there who have and do live for many years with permanent AF. When I was at your stage, I always self converted to nsr once I got up and was moving around. It is a trade off, cardioversion versus self conversion, the downside with self conversion is that you are generally in AF longer and it is proven that AF begats AF. PIP may work well for you, for me it didn't as I didn't tolerate the various drugs they tried on me. There are others here who may give you an indication as to what pip may best suit you as a vagal fibber.

What supplements are you on? For diet I found a big difference when I gave up eating sweets, baked food (cakes, biscuits etc) and anything that came in a package or was pre prepared - sauces, condiments, dressings etc etc. If your grandmother would not have recognised it then don't eat it.

For me, the combination of diet, supplements AND ablation has kept me in nsr up till now. If you find that diet and supplements are not helping you then I'd recommend you have an ablation.

Allan,

Do you have that article? I would love to read it. I have not found anything like that at all and the prevailing attitude among those I've spoken to is that it makes no difference. Still, i'd like to minimise any chance at all.

Monty

Monty

My recollection is that it was not an article or paper he was presenting, I believe the comment was made during an interview he was doing.
The link to the interview was in a post on this board, I know it was before I had my 1st ablation so it was sometime in 2006. I'll have a dig around and see what I can find.

Allan