Threshold Considerations for Treatment(s) for Afib?

I've done lots of reading here and also visited many of the links that have been posted.

What do most of the EP's, Cardiologist and especially sufferers of Afib consider to be thresholds to meet before certain treatments?

Ablation - paroxsymal, once every 2-3 months only @ night for 2 or so hours? Or worse?

Pacemaker - with both Brady and Afib when does one consider this option? For some reason haven't had a low heart rate notification in over 3 months.

Only take Eliquis. Didn't do too well on Metoprolol or Flecanaide BUT was on steroid pack after 3 week trip to Switzerland and hurt left knee & right ankle. Plus had underlying infection in 2 very old, 35+ year, root canals that had to be retreated plus 2 rounds of antibiotics. Plus had 2nd lifetime colonoscopy and did not do well with second dose of the dreaded drink and passed out on floor and vomited remainder of the solution. Plus EP doubled Metoprolol and added Flecanaide during all this over the course of about 60 days so to me it isn't any wonder I did horrible with it.

"They say" 33% of people with Afib don't take it seriously enough. While I don't like my episodes of Afib in the middle of the night I'm just not sure IF they warrant ablation or a pacemaker just yet. My worst triggers are stress and anxiety which I try but I'm a worrier. Dehydration, trying to do better, And lastly Alcohol. I enjoyed my glass(es) of red wine but have quit, occasionally would after that have a specialty craft beer with my husband but have quit that too. Also positional and try my best not to wind up on my left side @ night.

Should I get a second opinion just yet? Have cardio appt next week and EP middle of Feb. To me, they seem to push stuff but maybe I'm overly sensitive after he implanted a heart loop monitor and then wanted to do a pacemaker so soon and with all that was going on that I detailed above. That was 2 years ago and I feel like I've been doing ok with the exception of the random episodes.

Thanks for any thoughts.

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Qwackertoo
Ablation - paroxysmal, once every 2-3 months only @ night for 2 or so hours? Or worse?

Pacemaker - with both Brady and Afib when does one consider this option? For some reason haven't had a low heart rate notification in over 3 months.

Pacemakers (PM) are generally for someone who has long pauses between beats. I don't know what the threshold is set at on your monitor for low heart rate. I commonly have heart rates in the high 30's and low 40's during sleep and this is not an issue. PMs generally don't help afib, they set a floor for your heart rate. There are some that can shock you back into rhythm, but I don't think this is warranted for episodes that come every few months for two hours.

Going for an ablation would be OK, but certainly isn't an urgent priority. If you do decide to go the ablation route, the advice here is to choose the best EP you can. Someone who's done thousands of afib ablations at a top notch center. Here are Carey's suggestions for EPs [www.afibbers.org] .

Sticking with your current plan of dealing with stress, avoiding dehydration and alcohol makes a lot of sense.

Hold off getting a pacemaker until you run out of options and it is necessary if you get pauses or SSS. It’s not a treatment for afib.

In the beginning of my journey I had frequent a fib lasting from 1/2hour to 2 hours mostly in the evenings or middle of the night. Then I started having long pauses when ever I would come out of A Fib, some measured as 9 seconds and a personal best of 18 seconds. The 18 second pause was caught on an EKG in the hospital, the next day I had a pacemaker. No more pauses but the AFib continued until I had an ablation 8 months ago. I have been in NSR since that day last June. If your episodes are keeping you from quality sleep its just a matter of time before you are worn down and tired. My ablation so far has been a game changer for me. Yes sleeping on my left side was almost an instant trigger for me, its no way to live. Best of luck in your journey trying to figure this out. Cal

Thank you very much GeorgeN. I appreciate the reply and I will definitely check out the list and bookmark it for possible future use. I do feel they pressured me into the Implanted Heart Monitor after one visit with the EP after referral from Cardio then he quickly advanced to Pacemaker pressure 2 years ago. I felt like he was more of a salesman for Boston Scientific. I know, that is bad to say but how I felt. Especially after all the up & down with that short 3 months in-between when I was getting several dozen low rate notifications even in the middle of the day on my Apple Watch during that time and he said he wasn't "worried" about low rates and the boom lets schedule an appt for a Pacemaker with no further discussion.

I've been a little hesitant to exercise much this past 2 years but started back on the treadmill yesterday. And will try to get back to my previous twice a day, but only 30 minutes each time. I've really fallen off the excise wagon with this heart situation.

Thanks susand. I have had 2 legitimate pauses. I think they weren't false. Barely 3 seconds. According to the monthly implanted monitor reports. There was one the declared as "false".

calvin, Wow 9 seconds and 18 seconds. Especially the 18 seconds. Great to hear you are doing so much better. Between the years of Covid and staying home and doing mostly nothing and now these past 2 years with afib I feel like I'm missing out on things and worried about travel etc. I do worry too much, always have and this hasn't helped.