Ablation, first line treatment or last resort?

Hi Folks, these days is ablation considered a first line treatment or last resort?

First line.

It depends on how afib impacts your lifestyle. I had afib for 11 years (six years on meds after finally diagnosed), with over 200 documented episodes in the last 6 years. Afib had little impact on my lifestyle which was/is very active, usually an interruption for a few hours at a time, which only meant that I would not do a workout while in afib. Afib impacts others in many ways, but I think I was a lucky one.

Eventually, I wanted to go on extended hiking trips in Europe and having an episode during a 10 mile hike would have been an issue while hiking with a group. Thus - it seem reasonable to seek an ablation, which was successful for 13 years.



Edited 1 time(s). Last edit at 08/15/2021 02:10PM by Ken.

Congratulations for having 13 years afib free!

I decided to go medications first. Managed for 3-5 years that way. (I was also born with congenital stuff that has been repaired.) I have had more and more ECVs. Maybe should have done earlier?? IDK. But I don't look back.. (much)..

Ask a lot of questions (here and to your doc...)

I should have noted that for the 6 years of diagnosed afib I had only one ECV, which really wasn't needed because I always converted on my own. My longest episode was 3 days.

Even if it's now considered first line treatment, I can't imagine a cardiologist saying "go for an ablation" without first trying at least one drug.
I imagine it's very rare going to see directly an EP when one's heart rhythm goes crazy.

[www.medpagetoday.com]

Atrial Fibrillation: More Evidence Favors Cryoablation
—Recent studies have demonstrated a lower recurrence of atrial fibrillation in patients treated with cryoballoon ablation compared with patients treated with drug therapy.

Quote
Pompon
Even if it's now considered first line treatment, I can't imagine a cardiologist saying "go for an ablation" without first trying at least one drug.
I imagine it's very rare going to see directly an EP when one's heart rhythm goes crazy.

A cardiologist who's fully up to date on their continuing medical education might do exactly that because multiple studies have shown that ablation is superior to antiarrhythmic drug therapy with paroxysmal afib (not persistent). It's now generally accepted as first line treatment. In fact, I went directly from diagnosis by my primary care doc to ablation by an EP without any attempts at drug therapy, and that was in 2010. No one questioned that even 11 years ago.

I'm sure things differ from one country to the next with national health care rules and so forth, but I think the "must try AADs first" rule will go away entirely, at least for paroxysmal AF.

Carey, when I was first diagnosed with paroxismal afib, nearly six years ago, the cardiologist I met and performed the exams talked about ablation. She said I was a good candidate for it. But all that was new for me. I'd heard about afib, but nothing about burns in the heart chambers.
She prescribed me propafenone and arranged an appointement with a rythmologist a couple months later.
That's why I think it's rare going instantaneously for an ablation. Before being diagnosed, chances are great the patient doesn't know much about it. And even the most open minded one would be a little afraid by the procedure. Time to decide and have the appointment, the patient tries some drugs.

I think ablation is a first line treatment, and no matter what drug therapy is attempted, afib will progress over time. My cardiologist at the time my afib was diagnosed suggested ablation, but wanted to try drug management for while to see how I did. I did very well as explained above. When I was more inclined to get an ablation, My Dr. suggested a specific electrophysiologist that was excellent, but needed more ablations under his belt. So I waited a couple of years for him to gain more expertise. My cardiologist was a friend and the story played out well. 13 years of no afib, then it came back in a rush. Second ablation with the same Dr. and so far so good. Dr. Kevin Wheelan, Dallas, TX.

In my opinion, afib is never completely cured, just managed.