Ablation or not

Advice appreciated for this newbie.
I had my first episode 7 years ago, then 4 years nothing and bang the second one. Two and a half years later the third one. My cardiologist says : here is your pill in the pocket, live with it. My EP says: do ablation you are ideal for ablation. I preferred the pill but 8 months later came the fourth episode. I noticed the time between episodes was getting shorter so my thinking is that ablation may be the way to go.
The episodes are violent causing a trip to ER every time.

Go for the Ablation if its a coinflip situation you seem to be in for no other reason but for mental peace of mind knowing help is on the way + it is only going to get worse esp. the more you worry about it + for good reason...the worst part for me when i was living with Afib was the constant thinking about when is the next episode coming + mine were coming around a dozen times a month....mental torture that ended with my suc. Ablation in late 2018 + having peace of mind after that was prob. better then actually stopping the Afib itself crazy as that sounds as i was in a sort of mental prison or having the feeling of being held hostage.

I used a PIP (propafenone) chewed in the 1st 5 min. of the start of a episode to ko my ARR. in an hour or so + i am reading that you are taking a PIP but everytime you get an episode you end up in the ER so what kind of PIP are you taking because it obviously is not doing the job?

Flecainide. It makes the episode a little milder, instead of 180 bpm it is 140,
Peace of mind is part of the equation, I always think is there an ER close by where I am going?

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jrmnr
Flecainide. It makes the episode a little milder, instead of 180 bpm it is 140,
Peace of mind is part of the equation, I always think is there an ER close by where I am going?

Its good that it makes it milder but it should stop it in its tracks in no more then 3 hours max. otherwise a PIP is not doing its job...you need a higher dose of Flec. or maybe try chewing the dose your currently taking like i did Propafenone as you get the kick up front in the 1st hour or 2 before waning but that's when you want this gone right the earlier the better or try Propafenone 150mg chewed as soon as your episode starts...it was my best friend for about 8 months before my ablation.....out of about 80 times yes 80 times i used it.....it went 80 for 80 when chewed at an ave. of a 1 hour conversion time after the swallow.....an absol. miracle maker for me esp. mentally knowing i have this powerful solution to a horrible malady that never fails.
It is like a freight train once it gets going its really hard to stop so your best chance is very early before it gets its momentum going in cruise control.
George a poster here has chewed Flec. in the past + i worked for him as i recall so chewing a low dose amount of PIP is both safe and Very effective in my exper. anyway....GL.



Edited 1 time(s). Last edit at 12/19/2021 01:26AM by vanlith.

Thanks, good to know. Fortunately, my episodes are rare.

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jrmnr
My EP says: do ablation you are ideal for ablation.

You might be "ideal for ablation", but remember: there's NO easy case. Sometimes, the EP may think so, but it's only when you've been ablated and afib free for a couple years that one may say it was easy.
Many people here would tell you to choose a highly experienced EP. If you go for an ablation, don't trust the guy next door, unless he's this kind of experienced EP.

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Pompon

My EP says: do ablation you are ideal for ablation.

You might be "ideal for ablation", but remember: there's NO easy case. Sometimes, the EP may think so, but it's only when you've been ablated and afib free for a couple years that one may say it was easy.
Many people here would tell you to choose a highly experienced EP. If you go for an ablation, don't trust the guy next door, unless he's this kind of experienced EP.

I echo what Pompom says. Around 2010 or 11, there was a fellow here who'd had a 2 month or so episode early in his afib "career." Then he had relatively infrequent & short episodes for quite a few years. Lastly, his afib started progressing. He was from Boston and talked to several EP's there. They all told him his was a "simple" case. He contacted the team in Bordeaux, Fr and they said he'd be a complex case. He went to Bordeaux (an international center of afib ablation excellence) and was successfully ablated. His case was complex.

When speaking of simple or complex, in a simple case, a PVAI (Pulmonary vein isolation ablation) will solve the problem. The issue is that this is all many EP's have been trained to do and they don't have the training to address more complex cases. One should always assume they have a complex case and go to a high volume center with an EP who has the training to address a complex case, if necessary. I was chatting with Shannon yesterday about the case of a woman who has been messaging with me privately for a number of years. She was ablated recently in Australia with one of their top EP's. The ablation did not solve her afib as only a PVAI was performed. To solve her issue she needs to go to an EP with the skills to address a complex case.

How an afib episode impacts your lifestyle is a component of an ablation decision. I had over 200 episodes lasting from 2 to 72 hours during the five years of afib before my successful ablation. For the most part, my afib was an inconvenience and irritant, but life went on about 99% normal. Increasing episodes and international travel pushed me to choose an ablation.

Ken, congratulations on your successful ablation. How long ago?
I completely identify with the fear of travel and the progression of afib.

I have a longer history of heart issues (since birth).. afib for about 10 years. I am now in constant afib but before this last July I was using Tykosin successfully. Flecanide never worked for me. So I used to go to the ER because they were violent as well. This last July I went.. did a cardio version that didn't work (that was the first time that happened). They were going to admit me (it was a local hospital and not where my cardiologists were.). So I called my EP group-- talked to the doc on call (because it was 4 am on a Sunday morning) and said.. "is it safe for me to go home on cardizem?" He said yes. So I signed myself out. The doc there was ok with it but saying she wasn't OK with it.. ANYWHO... what I am saying is that I was able to go from violent to not by reducing the rate. They have offered up the ablation all along. It was my choice (as it should be). If I could re-write the clock with what I know now-- IDK. Maybe I would pursue the ablation but I also didn't have the EPs I have now. I have done 3 EP visits in the last few months (one was Natale) and they have been helpful in guiding me. I actually was set up for an ablation in October and they saw something on the TEE that looked like a clot (which wasn't) so it was postponed. To help make your decision I would personally video meet with Natale. And find a couple local EPs and do several visits. Sometimes it is TMI but I think more info is good. The last EP I saw, I told her I wasn't going to her (I don't like some things about her hosptial), but she helped me work thru my decision making process. I also am starting to learn that there are 1000 different ways the outcome can go-- if you do ablation first, or drugs, or just stay in afib...People will say "if you do this and such .. that will happen." And yet there will be tons of exceptions to that scenario...

In a nutshell imho, It is good to get multiple opinions from the people that do it. I wonder also- is there a post on here of "all the questions you should ask an EP?" I am sure there is.

Enlightening post, thank you.

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bettylou4488
In a nutshell imho, It is good to get multiple opinions from the people that do it. I wonder also- is there a post on here of "all the questions you should ask an EP?" I am sure there is.

Not that I know of, and if there is it's probably out of date by now, so there's going to be a new one. It will be a group effort. Stand by.

A starter list:

Choosing the Right Doctor: 10 Questions You’ve Got to Ask (And What the Answers Mean)

https://a-fib.com/questions-for-doctors-and-what-the-answers-mean/

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jrmnr
Ken, congratulations on your successful ablation. How long ago?
I completely identify with the fear of travel and the progression of afib.

I have had two ablations, the first lasting 13 years and the second lasting 1.5 years and counting. My decision for an ablation the first time was because of wanting to hike in the Alps. I had done it before and wanted to go back, but I didn't want to have afib show up on the trail while with a group of hikers. Hiking from hut to hut or town to town, just wouldn't work while in afib.

My afib was only an issue when I was or wanted to do something physical (running, hiking, skiing, windsurfing, weights).