PF ablation after one symptomatic Afib episode?

It does seem early to me....but I'm not an EP. I was paroxysmal for five years, and cascading into more frequency quickly before I was referred to an EP. From there, in British Columbia, four months for a first consultation, but not without diagnostics first to determine the extent, if any, of ischemia or other problems that should be fixed first. Then, another four months before the procedure. Then, in six days, back to AF. And amiodarone. Seven months later, I got a call due to a cancellation and got my second ablation. That one took. I think you must be aware of the 'failure' rate of index ablations (25% globally, but quite a bit of variance, and here is where you look 'deeply' for a really good EP within a day's drive or a flight).

The level of troponin in your blood assays may make the difference in your case. ?? Or maybe your high rate indicates that you're in some danger, particularly if you have concomitant RVR (rapid ventricular response). I think you should ask the direct question.....why so soon? And be prepared to be effusive with your thanks if the EP says he/she has you pegged and you're a great candidate that he/she can do soon. 😀

I would go get second opinion.
My Sister has had A fib like 8 years and was on a lot of meds for it for years . She’s 64 almost 65 now . The meds worked for a long time but then didn’t .
They did the ablation and loop recorder a year ago .
She had been in hospital a few times in those years tweaking meds .
The ablation helped her a lot but she wasn’t PF A fib .
I have that now PF A fib I’m going on 63 , had 1 st episode after my daughter wedding day 2 years ago , for hours . I should have called 911 it was so bad .
I drank too much alcohol ( over course of a long night ) also stayed up til 2 am . I’m in bed at 8 pm at home .
Next time I had some food that had a lot of preservatives in it that I wasn’t aware of .
Boom 💥 middle of night , Scary 2.5 hr event again w/ A fib !
Then another time a couple months ago after drinking something that was not healthy for me . Scary mid night 2 hrs .
Then last night , I ate too much ( my gut is very empty in day as I can hardly eat anything. Had a drink early at 4:30 pm . Again woke to A fib bad at 4 am til 6 am .
Went up to 160 bpm then stayed at 145 a long time .
Took my Heart ♥️ Calm supplements for when I get pvcs ( on and off most of my life ). It’s triple magnesium ( 3 kinds ) w/ Q-10 and some potassium, took Pepto as my gut was exploding and anti anxiety med . Did deep breathing for over an hour .
I’ve done halter monitor several times in 20 years.
Saw EP too , he wasn’t concerned about the PVCs or PAC’s
Showed him off Apple Watch / I phone the A fib episode.
He said here take flecidine . It had only been 2 nd time . I didn’t want to go on that daily !! That stuff can make you worse.
So I filled it and took half 2 x a long time ago .
I do not want to take it , it’s more of a preventative not when you are in A fib med .
I have chronic digestive disorders 10 years daily so so bad . It ruins every single day.
I’m recovering from last nights episodes all day .
Gut and intestines in shambles of course .
We only eat at home 🏠 never out and healthy dinner. I can’t digest many foods so I don’t eat and am starving most of day .
Let us know what you decide.
Your Dr may be just looking for money 💴! Be safe .

@gavia2 I had my first episode at 63, 10 years ago. I have had episodes once a year, sometimes every two years, and last fall I had a small cluster of brief ones due to stress. My last episode was April so hoping to go a year again.
I have rapid ventricular response with heart rate just under 200. Low blood pressure makes treatment tough so I usually land in ambulance, ER, even ICU.

I was offered anti-coagulation with the first episode, which I declined. The cardiologist in the hospital for the next episode told me to "go home and forget it happened."

Recently I saw a cardiologist who suggested ablation and sent me to an EP. EP said that if he had done an ablation on me and seen once/year episodes he would consider it a success. So no ablation. This was MGH in Boston,

There seem to be a wide variety of approaches in other words! To address my triggers I drink low sodium V-8 for potassium, take magnesium, don't eat after 6, don't lie down after eating, and am careful of my chest when lifting. I don't have caffeine or alcohol. Everyone is different. I was glad to see that a book called "The Afib Cure" mentioned some of these strategies!

Why were you on amiodarone? I don't know much about it but it looks like it often addresses ventricular issues. I have a "pill in the pocket" Rx for diltiazem, which is what the ER uses on me too. It brings the rate down. The EP gave me a pill in the pocket Eliquis to take after an episode for a few weeks, depending on how long the episode is.

I basically am still not medicated at all. Ten years, 10 episodes total.

I won't comment on your dilemma regarding whether to have the ablation as there seems to be a lot going on there and I'm not qualified to provide advice. I have had two ablations, however, including a pulsed field ablation at Mayo Jacksonville about a month ago. I had zero complications both times. The first one in 2018 successfully treated SVT, and the second one afib (at least so far). Hopefully my experience can provide at least a little comfort for you.

You throw up red flags and you understand these are red flags. As a scientist you have a better perspective than the average person. Your complaint that the doc is non communicative is a red flag. Not getting your results is a red flag. Amiodarone is a nasty drug. What purpose do you need it after an ablation? Kardia is very useful. You can monitor you HR and get a good reading in a 30 seconds. You do not have to use this EP and you do not have to go through with this surgery if you do not want to. A 2nd opinion sounds necessary.
That said I am going in for my 2nd ablation 5+ years after my 1st. My HRs are low (70S-80s) and BP good during the events which last from 6-36 hours. I so far have self converted on all events since my first ablation. I had only 3 Afib events in the 4 years after 1st ablation. But since last fall they have come on average once a month. Other than eliquis I do not take any heart meds. My resting is 48-low 50s.
My brother's first EP wouldn't talk to him. He said he does ablations and only ablations and that was that. He moved on.
1/2 life of Amiodarone is long 15 to 142 days. It has an active metabolite, desethylamiodarone that has a half-life of 75 days
"Amiodarone: 7 things you should" knowhttps://www.drugs.com/tips/amiodarone-patient-tips

Amiodarone does have some 'issues', but it can keep a person with a really cranky heart in NSR until an ablation or some other intervention can take place. I was on it six days after a failed ablation...yeah, only six days and I was back in the ER with a runaway heart. It took 800 mg each day for seven days to get my heart back under control, but amiodarone did that for me. Then I went on 400 mg per day for three weeks, followed by a two week taper at 200 mg/day. Two months after that, back in AF and I waited for another ablation, which thankfully has been good for about 18 months now.

Iodine is the displacing component in amiodarone, and due to that, each patient must be monitored closely for signs of pulmonary hypertension, liver problems, etc. According to the internist who prescribed it for me (he managed to consult my EP via telephone, probably a miracle!), one can tolerate amiodarone for literally years, but it becomes more and more dangerous over time. One is meant to use it for only as long as one must. And I agree about its bioavailability and half-life....they can go months.

There is one other hefty component that few know of or are willing to countenance: motivation and attitude. This is a psychological component to one's well-being. If one is disposed toward conspiracy theories, danger around every corner, or that the health care system is 'out to get you', one is unlikely to profit from any proffered remedy. If a person feels charitable toward others, and is willing to trust that most physicians have good will, beneficence, training, morality, ethics, and a strong desire to keep learning in their orientation to their science and craft, one can expect to do well for the most part. Cardiologists and EPs know the heart backwards, sideways, and up and down, and they know how to manipulate its function. From there, the actual hand/brain connection can be the limiting factor, just as it is between the world's best piano virtuosi and your average lounge guy.

After reading your post I felt like I was listening to my own experience. I went to ED the evening of Oct 12, 2022 with pressure in my chest. That night I had my first identified Afib event with my HR just under 200. After trying several other options, they got my heart back in NSR by morning with a Diltiazem drip. I saw the cardiologist that morning who said my options were medications to control rhythm and rate along with Eliquis or I would be a good candidate for an ablation. So long story short, in that 5-minute conversation I decided I didn't want to be on meds and said I'd like to go with an ablation. She then put me on Amiodarone (loading dose then down to 200 mg/day), Diltiazem and Eliquis and scheduled me with the EP at my hospital. Testing before the EP visit showed no issues. The reviews for this EP were good so I kept the appointment and was very impressed when I met her. The ablation was scheduled for Valentines Day 2023. The same as you, I am a scientist, Laboratory Medical Technologist for 47 years, so I did a lot of research before that day. I found one Canadian study that was reassuring to me even though my ablation was going to be thermal not cryo. https://www.news-medical.net/news/20221107/National-study-sheds-light-on-how-to-more-effectively-treat-atrial-fibrillation.aspx My procedure went well, no real complications other than a reaction to the Carafate I was on after the ablation. Once that was resolved, I continued on the Amiodarone, Diltiazem and Eliquis for the following 3 months with no problems. I then went off the Amiodarone and Diltiazem but have continued with the Eliquis since I was 69 at the time. My EP said that based on my CHADS2 score I would have been able to discontinue the Eliquis if I had been under 65, but not so for me. In July 2023 I did a 30-day heart monitor which showed no Afib events. As I've mentioned in a previous post, post ablation my resting HR increased from 60-70's to between 78-82. I may have had asymptomatic Afib before that one event, but once it was official I had to make a choice and so far I am glad to have chosen the ablation.

I wonder why doctors are treating me so differently. Not only am I on no meds after a first episode with heart rate near 200, I have had 10 more episodes, and noone prescribes meds other than as needed. I am over 65 and female so CHADS2 score is 2. I am happy with meds as needed but it seems others on this forum are put on meds and/or have ablation after one episode.

I work at avoiding triggers and lifestyle risks and am trying to keep my frequency down to an episode/year but at some point it will surely increase.

#1- your afib did not resolve on its own, which means you needed conversion. Paroxysmal AF, the lowest stage of AF, converts back t sinus on its own.
#2- 240 HR is really high, even in AF.
#3- low resting HR means drugs like beta blockers to keep your heart in rhythm will lower your HR to near syncope levels (happened to me). did they try flecainide?

My best guess is you've had minor symptomatic and asymptomatic AF for awhile. Not sure why they wont give results of loop recorder, but mine were all clear aside from some bouts of anxiety related tachycardia. If your AF gets worse or you're diagnosed with persistent AF then PF ablation success rate is lower. Get it done now if possible. If you're in good shape you'll only be out of it for a week and back to normal schedule in 2 weeks.

My Afib experience started when I was going to have a routine colonoscopy. The cleanse caused my heart to pound and when I went to hospital the next morning they found I was in persistent Afib with RVR. This was in March of 2023. I had had several holter monitor tests including one for 5 days and no Afib appeared but my cardiologist at the Mayo said it must have been there as it doesn't start as persistent. EP at Mayo said the same. I was 79 years old and had been diagnosed with Apical Hypertrophic Cardiomyopathy in September of 2022. Strange to find a genetic heart disease as an elderly person but I guess it happens. I am in good health, walk 3 miles a day and exercise with light weights. I am not overweight and I eat right. Rate control was tried first with Metoprolol with increase in dosage twice. Caused my BP to be too low but didn't control the rate. Changed to Diltiazem until I could get into the Heart Rhythm Clinic. It also didn't control the rate. My EP at Mayo gave me all the options and when I asked his recommendation he said he would start with medication as ablation is irreversible. I decided to go the medication route and he scheduled me to load Dofetilide (Tikosyn). I admit the loading process scared me, but it went well. I did have to have a cardioversion but since September of 2023 I have been in NSR except for one small breakthrough early on. I am praying the medication continues to work as I feel great and am active. I did tell my EP I was a need to know person and had researched the antiarrhythmic meds and that I would not take Amiodarone. Couldn't take Flecainide because of the ApHcm.
We are all different and sometimes it is difficult to decide what is the best choice. Good luck with whatever you decide.