40 year old considering ablation

Hi all - I was first diagnosed with afib in 2018, with episodes happening twice in one month. First incident resulted in an ER visit with a chemical conversion, second converted on its own within an hour. My cardiologist I met with after the ER encounter was ready to do an ablation after the second round, I decided to wait and it was almost two years before I had another afib incident. This time, I had flecanide on hand as a PIP which worked great an hour after I took it.

Last month I had 3 afib episodes. Of course my EP who wanted me to have the ablation back in 2018 said that is the next step. These episodes except for one were all the day after alcohol consumption. I have avoided alcohol so far this month and have had zero issues with afib. I am having a tough decision on going forward with the ablation, or to see if abstaining from alcohol will buy me some more time before the ablation needed. I feel like the PIP (which has worked every time) moving forward without alcohol is doable and worth a try, but didn’t know if anyone else has had similar experience and any advice. I currently have a second opinion scheduled with another EP.

I've successfully used PIP flecainide for 18 years.

If nothing else, you should put off your ablation till pulsed field ablations (PFA) are standard of care as what you are doing is working reasonably well. Second, choose your ablating EP carefully if you do decide to get an ablation. Afib ablations are a combination of art and technical skill IMO. People around here commonly suggest using a high volume center with an EP who has done thousands of afib ablations. I'm sure others here will have suggestions.

I would absolutely, positively not seek an ablation at this time. You need a consistent history of recurring episodes to justify ablation. Keep up with the alcohol abstinence and see what happens over the next few months. If you do have episodes despite not drinking, take your PIP and see how that goes. If you can avoid afib with abstinence and stop it on the rare occasions it does occur with a PIP, then I agree with George that you should wait and manage it.

When and if it does become unmanageable, you should seek an EP with thousands of ablations under his belt who is using PFA, which will hopefully be generally available by that time (it's still in trials). Your EP seems way too eager to do an ablation at this stage.

Another thing that many of us find helps keep us in rhythm is a good electrolyte balance. If you have recent tests, check your numbers for potassium and magnesium. Many have posted on their favorite blend of magnesium but potassium may even be more important. Keeping it at the top of the normal range (about 4.5) really makes a difference. In the first years a hefty dose of food-based potassium would even convert me. Carey tipped us off to low sodium V8 which uses potassium to replace sodium. Even on of the tiny 5.5 cans has 600 mg of potassium.

Carey is right about alcohol. Not only here, but everywhere I've read people's comments about their afib, alcohol is certaily, beside well known health issues, the most common trigger of afib.
Those who say alcohol isn't a problem for them usually insist on the word "moderation". One glass may sometimes be harmless. More than that... I'm sure it's rarely the case.

The fantastic advice you are getting in these posts on this thread are EXACTLY what you should have gotten from your EP.
No wonder the trust in Doctors is at an all time low.....i could say more but the mrna covid 19 Vax subject is off limits here.

Anyway CZK i would consider the advice you get on this 2nd to none Afib forum more reliable frankly than most doctors or even a great deal of EP'S themselves because we are the foot soldiers...we have and/or are currently living with Afib so who better to ask.....esp. when so many of us have followed so many other people's stories here + have learned so much from them + then combined it with their own exper.

All the best

Thank you all, I appreciate the feedback. It definitely relieves my anxiety to hear of real world cases instead of worse case all the time. I am looking forward to my appointment with another EP, and will be very selective.

I'd easily give up alcohol for freedom from AF. I crave a sip now and then but not worth it over all.

I would just drop the 1st EP.

I also started experiencing AFib from 'binge' drinking. I have found I can nearly eliminate the AFib by taking amino acid supplements that were used in case studies and cited on the NIH.

[pubmed.ncbi.nlm.nih.gov]

The key amino acid supplements found to be beneficial are Taurine and L-Argenine. I am trying to manage a recurrence right now, and have discovered that dosages of several gram a day are needed to eliminate the arrhythmia. I was getting good results with only 2g/day each, but the condition recurs in the wee hours of the morning. I am now introducing a formulation that prolongs the presence of L-Argenine in the blood stream by adding Citruline. I am hopeful this will virutally eliminate the issue. My doctor wanted to put me on beta blockers after reviewing the Holter monitor, and I am feeling positive now that BB's will not be necessary.
Best wishes !

I am 65+ and started having alcohol related AFIb 15 years ago. I am still able to consume alcohol, but I try to limit it to only about once a week.

Just an update since my last post....Since eliminating alcohol I've had two more afib episodes, both were about 1 hour after falling asleep at night and I woke up in afib. The first one resolved rather quickly (about 5 minutes) with a vagal maneuver. The second one was a lot more difficult, after trying vagal maneuvers for about 30 minutes, I took 50mg of flecainide and it finally resolved about 4 hours later. I felt really good that I was able to kick the first one quickly, but the second one has really knocked my confidence down. Now I feel like it is more than alcohol related, maybe sleep apnea? The majority of my episodes have been waking up in afib, so maybe there is a connection. For those who have delt with this for many years, did you go through rough patches with a lot of afib before you got a break for a while? I had 1-2 years in between episodes before, but now I'm up to 5 times in the past few months. Has anyone had success reducing episodes with a sleep study?

After reading through the 101 on this site, it sounds like I have classic Vagal type lone afib. My last two episodes I could feel beats that felt a little quivery leading up to falling asleep and waking up in afib. My EP has me very worried about this moving into persistent afib, but it sounds like this type rarely evolves into that? I would really like to interview a few more EPs before I consider moving forward to an ablation. After 5 episodes in a couple months my mind is telling me it is getting worse, but hopefully just a rough patch.



Edited 1 time(s). Last edit at 07/14/2022 06:44PM by czk.

It's untrue that vagal afib rarely evolves into persistent afib. Regardless of what tends to trigger your afib, afib is a progressive disease and in most cases will eventually evolve into persistent afib. That might take years, but it will probably happen eventually. Since you've dived into the Afib 101 archives you know there are people here who manage their afib on their own using various methods and have done so successfully for years, but unless you're very dedicated to the effort and willing to invest a lot of time and effort to find what works for you, the odds are you're on the same trajectory as most people. If you're on a course of increasing frequency, you're on a course headed toward persistent afib.

When you look for EPs to consult, the number one criteria you should be looking at is their experience level with afib ablations. The world is full of EPs who can manage your afib medically (ie, with drugs), but EPs who truly understand the mechanics of afib and can find their way around your heart and target the offending areas are not common. Don't base your choices on academic credentials. Those are important, but just like with surgeons, far more important is their experience actually doing the procedure. You want someone who has done thousands, not hundreds, at a large center that does thousands per year, not hundreds. Even if you're still undecided about pursuing an ablation, those are the EPs you want to be talking to.

Thanks for the advice Carey. I have two appointments with new EPs in September, one of them at Cleveland Clinic. My current EP does about 100 per year, and from the sounds of it this doesn’t seem like very many. I hope my frequency doesn’t continue to increase because I feel like my anxiety will take over and I will lose patience. I did have Covid the end of June, so maybe this frequency increase is due residual effects of the virus.

Sure, it's definitely possible that COVID was behind the increase, and that might last a while. Give it time.

Cleveland Clinic is a good place to start looking, but look at the EP specifically. Even CC has rookies.