Ablate or Wait?

I am scheduled for Afib cryoablation in early April. I had a successful flutter ablation in July but then started with Afib episodes six months later. I have had three very long Afib episodes but now my heart has been quiet for over two months. I’m on eliquis and bystolic and am 60 years old. I have no other heart conditions. My question is should I wait or is this the time to do it? Before I have further episodes and more damage? Opinions welcome. Thanks

Cindy,

When you say 3 VERY long AF episodes, what do you mean by very long? How far apart were they? Did they resolve/convert on their own or were you cardioverted? In which country do you live? Who did your flutter ablation? So far as I'm aware, it's usually an AF ablation that can precipitate AFL rather than the other way around but we're all different I guess.



Edited 1 time(s). Last edit at 03/27/2018 04:18AM by mwcf.

I had episodes exactly 4 weeks apart and one two weeks later and then all quiet. They were between 12 and 16 hours long. I have a loop recorder implant that tracked this. They stopped on their own I didn’t go to the ER or anything and don’t want to be on any anti arrhythmic drugs yet. I’m at Ohio state university, a high volume center, and cannot change EPs and there is no need to anyway. I was warned that once the flutter was fixed Afib may show up and unfortunately it did.

Thanks for the additional info Cindy. It sounds like your AF is definitely paroxysmal (episodic) and, as such, should be a fairly straightforward matter for a high volume ablation centre to sort out for you (-:

Mike F.

I'll be honest I waited until my episodes were a bit more frequent. You just don't want to wait too long they say the heart remodels......idk. In other words I guess as episodes increase they gain memory. With afib not sure there is a "straightforward" I think there are " one n Dones"out there but I'm not one and anyone I've had close contact with isn't either. Natale would be about as close as you could come. I def have had great relief with afib and ablations, but it seems eventually other problems or the devil itself creeps back in. My experience is I don't like afib when it increased to episodes too frequent I went. It's all in how bad it bothers you . You know there are lots and lots of people who live in afib Daily.

OK tsco agreed there's no 100% 'straightforward with AF', but my point was that the odds are good (as in 80% or a bit better - with one or two procedures) that with fairly recent paroxysmal AF like Cindy's a good high volume centre will be able to sort this out for her. Any procedure/s should also be more relatively straightforward the sooner she takes the ablation route rather than waiting. Even if ablation isn't technically a success it almost invariably dramatically reduces AF burden in terms of frequency and duration. That said, I too have waited whilst AF episodes have been a couple of times a year and of short duration. But now 19 years on with procedures having improved and I'm heading down the ablation route myself. Agreed Natale is the maestro but Cindy states she can't change EPs anyway (well, presumably without paying privately).

Regarding your comment 'You know there are lots and lots of people who live in afib daily', I have a close friend in the US (very wealthy) who has chosen to live with AF this last 12 years (obviously with RC and AC) and she is fine, travels all over the world, breeds and rides horses (daily) and has forgotten she even has AF. Her father also lived similarly from 50 to 90 with permanent AF. I'm hardly advocating this approach, but if it comes to it then for many folks (none, if any, of whom will ever frequent forums like this one) AF can be lived with without too much of an adverse effect on either QOL or lifespan. RC is obviously critical to avoid HF. Another friend of mine here in the UK aged 72 has just had a PM for her persistent AF as her RC meds were resulting in bradycardia and several-second pauses in the night. She feels absolutely fine and no longer has any adverse impact of QOL.My mother's husband is rather more problematic situation at 85 with persistent AF and severely enlarged left atria and severely impaired LV function (advanced HF - 3 on scale of 1 to 4) so our current concern is how best to manage him.

Regards,

Mike



Edited 1 time(s). Last edit at 03/28/2018 03:45AM by mwcf.

Cindy,

Would you be open to an antiarrhythmic on demand to cut short your episode and convert to NSR?

I've done this successfully for 14 years. My episodes are now very infrequent (about 5 times in 5 years now though there was a period of time where it was more frequent and initially I had a 2.5 month episode.

George

Thanks everybody for responses. Yes I am willing to try the pill in the pocket approach. Many EPs are not fans of that but mine actually mentioned it after I was told by his nurse he rarely authorized that. But then we started talking about another ablation and at that time I was having more frequent Afib. So I think I’ll call the office and ask what they recommend at this point. I know I’m likely to start back up again but it’s odd that I haven’t. Cindy

Just FYI, I went ahead and had the balloon cryoablation and then an RF touch up of a flutter circuit that had not appeared on any other tests or during my first ablation. I’m doing ok. Still a bit tired though.