Looking for Advice/Insight

Hi,
In July of 2017 I had stroke due to undiagnosed Afib. Fortunately, for me there was no significant physical impact. However, I did learn that I had Afib and that another stroke was potentially lurking. So far so good, I haven't had another stroke. I was diagnosed with Paroxysmal Afib and have been on Eliquis, Flecainide and Metoprolol since the stroke. Lately I've thinking that I don't want to be these meds for the rest of my life if I can avoid it. So, the question that I've asking myself is, do I get an ablation or not. I'm a 63 yo male that is fairly active and energetic. At times though I been feeling more chest pain associated with episodes of Afib. I'm not sure what this may indicate. Am I just prolonging the inevitable by not getting an ablation. I've had stress tests which all come back fine. I've also had an aortic ultrasound as well and that came back fine. I'm scheduled to see my cardiologist tomorrow and I'll be sharing my thoughts with him as well. I just need some perspective from those of you that may have been in similar circumstances.
Thanks for any information that you may care to share.

MJ

How often do you get episodes, and how long do they last? Are you able to control your Heart rate while in AFIB?

I think that having had a stroke, you'd want to stay anti-coagulated in any case. The advice here for those who choose ablation is to go to the very best, with an ablationist who has done many 1,000's of complex afib ablations. Used daily, the flec commonly has a loss of effectiveness over time, for many. However the time of efficacy can be long for some. Metoprolol will help keep your rate low when in afib and help prevent flec from pushing you into high rate flutter other times (a potential side effect of flec). If you don't want an ablation, but would like to reduce or change meds, then you need a plan that you will likely have to construct yourself (I have, there are risks to this approach, too & no guarantees of success). Most docs are wary to stray far from standard of care.

Hi,
The episodes are unpredictable. When they do occur my rate rate is usually not too elevated. My rate may go as high as mid eighties. Also, I can go days without going into Afib. Then I have days when I'm in and out of Afib. I try to make a note of my behavior, food intake and other things that may induce it.

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GeorgeN
I think that having had a stroke, you'd want to stay anti-coagulated in any case. The advice here for those who choose ablation is to go to the very best, with an ablationist who has done many 1,000's of complex afib ablations. Used daily, the flec commonly has a loss of effectiveness over time, for many. However the time of efficacy can be long for some. Metoprolol will help keep your rate low when in afib and help prevent flec from pushing you into high rate flutter other times (a potential side effect of flec). If you don't want an ablation, but would like to reduce or change meds, then you need a plan that you will likely have to construct yourself (I have, there are risks to this approach, too & no guarantees of success). Most docs are wary to stray far from standard of care.

Hi, thanks for responding.
You make valid points. I live in the Boston area and believe there may be several Ep's/Ablationisht that may be worthwhile. Also, I'm reluctant to mess with the medications. For the most part I think I'm relatively stable. However, I am concerned about heart failure and other complications of Afib. I also have Graves disease and I think some of my issues may be attributable to that. I recognize that I need to educate myself more and advocate for myself. There is just so much information that at times seems contradictory. I appreciate your thoughts.

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Em Jaye
I live in the Boston area and believe there may be several Ep's/Ablationist that may be worthwhile.

Afib ablations, especially beyond a standard PVI (Pulmonary Vein Isolation), are difficult. There aren't that many fellowship programs that even teach how to work on the LAA (Left Atrial Appendage). Now, you may not need this, but it would be nice to go to someone who can handle it if the need arises. In the US, I send people to Andrea Natalé in Austin (in my opinion, the best in the world) or one of his protégés. Outside US, I recommend the team in Bordeaux, Fr. People wonder why you need to travel, but it really is worth it. Others may chime in with recommendations in the NE of the US.

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Also, I'm reluctant to mess with the medications. For the most part I think I'm relatively stable. However, I am concerned about heart failure and other complications of Afib.

Heart failure is primarily caused by longer duration high heart rates during afib. If your episodes are short or if longer, the rates are controlled to <100 (or 110, depending on the reference), then this should not be an issue. Hopefully your Metoprolol is doing this for you. The Eliquis should reduce the risk of stroke, your other major AF risk.

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I recognize that I need to educate myself more and advocate for myself.

Educating yourself and and advocating are very worthwhile.

GeorgeN,

Thank you for sharing your knowledge. I had an appointment with my Cardiologist today and he echoed your thoughts on ablation and my risk factors for cardiac failure.
He has scheduled me for a stress test just to be on the safe side. Ablation has never been my first choice. I'm not keen on an invasive procedure that is irreversible. It's been three and half years since I was diagnosed with AF and who knows how long I had it prior to that. It's curious that it was never detected during my annual physicals. In any event I feel better mentally after my appointment and responses that I've received here.