Whether to treat persistent afib with few symptoms

Started a new thread because I didn't want to hijack Torvic's.

Carey's comments on that thread have me wondering whether I should have proceeded with my ablation. For now, I am glad I did. I do not feel euphoric, as someone else mentioned, but I feel generally better. And I am not so tired at the end of a day of physical activity.

Backing up a bit; I was diagnosed with Afib one year ago when I presented myself at the emergency room with a feeling I called light headed. That is not exactly correct. It was as if my balance was off a tad when I turned my head.

So other than that, I was asymptomatic, but was found to have Afib 100% of the time. My heart rate was around 70, so no big deal. But I understood the internet advice to tell me it was going to continue to deteriorate. Not sure what I would have done if I had read Carey's advice back when.

Other notes are that the EP said my atrium was moderately scarred and slightly enlarged. He says it may go back to normal size now that I am in sinus rhythm. And if my Watchman lets me get off Eliquis, that will be a definite win.

Some people may get an ablation just to get off Eliquis. But apparently it his hard to get someone out of 100% Afib unless they go to one of the top EPs.

Although, it seems that after my ablation, it seems my CHADS stroke risk has gone up from a 1 or 2, to a 3? I believe I saw that in my chart. If I am correct it went up, I presume it's because my LAA was isolated?

Perhaps if my Watchman heals in successfully it may be reduced again.

It just occurred to me that if our ablations wear off over time that my LAA my become more active again.

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nonthumper
Perhaps if my Watchman heals in successfully it may be reduced again.

It just occurred to me that if our ablations wear off over time that my LAA my become more active again.

A Watchman and LAA isolation have no bearing on CHADS score. If you're a 2 (or 3) then that's for the reasons listed in the CHADS scoring system. But having a Watchman certainly does lower your risk whatever your score might be. Basically, it brings your risk down to levels comparable to people who don't have afib.

Expertly done ablations don't wear off, and anyone willing to ablate your LAA was an expert. What can happen is afib can develop in areas not addressed in a previous ablation, but it's unlikely that would be your LAA. The LAA isn't a sensitive area like the PV area is, so when an EP ablates it they can be more thorough. In any case, the Watchman largely renders it irrelevant forever.

I hope so. Seems like I just saw a discussion on here where people are hoping to get 5 years before they need another ablation, though.

I'm on year 9 and I'm by no means the record holder around here.

9 years AF-free after ablation sounds amazing and gives a lot of hope to many of us here.

Quick question, if you don’t mind—have you ever experienced any other types of arrhythmias, such as tachycardia or atrial flutter? Or has your heart been completely calm and normal?

I’m asking because I had a successful ablation 3 years ago, but recently had an episode of tachycardia (150–160 bpm) that lasted 45 min. and was terminated with diltiazem. This was the second episode of tachycardia in the past 10 months, so I can’t help but wonder if something might be going on.

Hi nonthumper

I haven't had an ablation (yet) but you probably did with the information you were given by the specialists.

Unless it had really bad consequences, having regrets is not going to help.

Regarding not treating symptoms, my understanding so far is that AF will end up doing damage even if you're asymptomatic. My cardiologist told me, "You're asymptomatic now but I can't leave you arrythmic for too long. Your heart is going to hate it."

I guess that what he meant by that was damage to the atria or more persistent remodelling leading to worse AF. He wasn't explicit but he's seen way more hearts actiing up than I have, so I'll trust his judgement for now. He seems intent on treating the arrythmia. I hope the cardioversion will be enough but if I need the ablation, then so be it.

Best of luck to you.



Edited 1 time(s). Last edit at 06/26/2026 07:15AM by Torvic.

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Yuxi
Quick question, if you don’t mind—have you ever experienced any other types of arrhythmias, such as tachycardia or atrial flutter? Or has your heart been completely calm and normal?

Completely calm and normal since the ablation in 2017. Prior to that I was anything but calm and normal. You should read my story.

Did anyone get an EKG of that 150-160 tachycardia? Whenever I hear of tachycardia with a rate near 150, I think there's a good chance it's flutter.

Thanks for sharing your ablation history and the good advice, Carey.

My Apple Watch ECG showed an inconclusive result. I now have a Kardia 6L and will use it next time if needed.