PF ablation after one symptomatic Afib episode?

Cardiologists are not a homogenous group. Hence you (like myself) are not on other meds while others have an aggressive treatment plan with more meds including Amiodarone which was developed to be used only for V-tach. Some consider it a bad choice for geriatric patients. I worked in a very large university based medical center for 20 years. Although I had very little if any contact with cardiologists I found working in the hospital based setting that there was a lot of politics in medicine and within specialties. Some specialties were worse than others.

@harbeywj as I wrote, the first cardiologist, 10 years ago, wanted to put me on anticoagulants and I declined. It's not like I just said no; we discussed it and he agreed to wait. He did prescribe diltiazem as needed (low bp was a concern) and then went to digoxin, which I did not take and told him so.

The next episode, for which I was hospitalized, brought a cardiologist telling me to go home and forget it happened.

This wide divergence in advice was certainly a tip off.

The first cardiologist eventually agreed that I didn't need meds (after a few years) and said that "maybe we are overmedicating people." I have no idea. I am grateful and perhaps lucky to have avoided stroke or worsening afib so far (knock on wood, last one was April which came quicker than previous intervals).

The EP I recently saw said my CHADS2 technically means anticoagulation based on age and gender but all my other factors are negative so he didn't want to do anything but pill in a pocket. He briefly considered flecainide. I have taken diltiazem at home maybe three times. He said no ablation.

I am going to try to stay home next time, and medicate with diltizem with lots of hdyration. I have a bp cuff and if it is too low for diltiazem I will go to ER. EMT's always want me to call 911 but last time I drove myself.

After 9 years of magnesium, low sodium V-8, walking and tai chi, early dinner etc. etc. I bought "The AFib Cure: Get Off Your Medications, Take Control of Your Health, and Add Years to Your Life" by Day and Bunch. I was curious. They say that an increase in afib is not inevitable and that many (some?) can get off medications. I am not sure I trust anyone in this field but was glad to see some of my strategies affirmed.

That said, the cumulative physiology of this may actually be inevitable. I have some EKG abnormalities now when at rest and not in afib. I will go on anticoagulants when this new EP recommends them. I finally found a "just right" approach- not too aggressive and not too laissez-faire that I can trust.

My biggest concern is that ablation done early is more effective. My mother had permanent afib and I saw what that can do. The timing is just something I will rely on the MD for. As I said, he would consider my so far once annual episodes as success if he had done an ablation.
We'll see how long I go now!

Two GREAT posts above. Read them again...if you're somewhat new to atrial fibrillation and have been so wound up that you haven't managed to bring yourself to read up more on the issue.

1. It's unfortunate, but atrial fibrillation is a progressive electrical disorder of the heart. It almost always gets worse over time, and the worse it gets, the more 'intractable' it becomes...meaning less manageable. So, you want to be in AF as little as possible, as seldom as possible, and you want to be in line for a catheter ablation BEFORE you progress into the more difficult 'persistent', and then the awful 'permanent' stages. Note: not everyone is bothered by symptoms, and some don't even know they're in AF. Great for them, although not great for their hearts. The rest of We the Great Unwashed who are heavily and horribly unsettled by the effects we do feel must find ways to keep AF at a minimum, but also we soon realize that the mechanical fix is the way to go in almost all instances. This is because the disorder requires higher and higher doses of the same anti-arrhythmic drugs over time....progression, remember?

2. Stroke is the single greatest risk for those in AF. You must go on an anti-coagulant as soon as you are diagnosed.

3. Being in AF much of the time will cause the heart to 'remodel' itself, and part of the process is enlargement of the left atrium. You want very much to avoid this condition. An enlarged atrium is difficult to ablate, for one, and it also encourages mitral valve prolapse. Again, this leads me back to my advice to see a competent electrophysiologist soon after you have been diagnosed, especially if you have three or four six-hour bouts of AF each week. Once again, you don't want to be in AF if you can help it. Take the drugs for a while, they should work, and you'll be more at ease. They tend to buy time well....for a while...and then you'll find you either need more drugs, or another drug, or you'll really, really, really, have become keen on an ablation by then. Best to have that available sooner rather than later.

I would not do ablation after one episode. Ridiculous in my opinion.

I am almost 76 yrs old. Had afib for 7 years from age 14 to 21, many episodes really bad lasting for hours. Then I read in a news column written to a doctor, that some people are extremely sensitive to caffeine. With no caffeine, I have no afib other than minor if under extreme stress or too many sweets.

If you drink coffee, colas, Mountain Dew, energy drinks, eat chocolate, or lots of processed or high sugary foods - Stop, and see if it disappears.

The keys I think are 1. how often Afib occurs 2. are the occurrences increasing 3. how high is HR and BP. I understand your thinking and I believe you are right on with your own decisions. After my 1st ablation I had a brief 8 hour episode 11 months out and then 16 months later and then a year later and then a year later. All brief < 12 hours and all < 90BPM and good BP. Then last fall I started with every 3-6 weeks still reasonably brief < 36 hours and < 90 BPM and good BP but increasing in frequency. I have not gone to ER and always contacted my doc after I have converted. But the increase in recurrence has lead me to go for a 2nd ablation. It's been 5 1/2 years and mapping is better and surgical techniques better. Kardia has helped a lot because my episodes are brief even just running over to urgent care to capture it on an ECG was futile as I would convert before I they took a ECG. Anybody who is recurring I believe in having a Kardia. My doc recommended it and that is how I have been able to document episodes. Also when I have PACs it is easy to see them on the tracing and I know the difference. An aside about PACs my doc is a firm believer that they are too hard to have a successful ablation and so he says no. Yet I read about some who are ablated for PACs. I like my doc and that says a lot. My 45 years working western medicine has left me with a bit of cynicism -:) never mind my experiences as a health care consumer.
I've mentioned here before about my older brother 81 has used medication for controlling Afib and he goes to a large medical center in St. Louis. Biggest problem for him is when he exercises he can push it into Afib but so far converts quickly. He thought it was going to fail in a year or 2 and then get ablated. I think he is right at 5 years keeping it medicinally in sinus.

@harbeywj thank you! I have had a Kardia for some time. It's funny, I went for a new battery because I had a feeling I was going to have an episode. I cannot account for that feeling. One week later I did! I have a mini-hospital on my shelf with oximater, bp cuff and Kardia!

One of my kids has multiple health issues and I took care of my very elderly mother for 8 years. I have learned to lean toward "slow medicine" and have sometimes felt I needed to be a safety barrier between my kid or parent and medicine. But when we find good doctors who listen, it can go well.

Keep Reading and learning about AFIB. STOPAFIB.org a good resource with accurate information from Top Docs. The technology and procedures are changing rapidly. I was a doubter too for 5 years. Last year I had loop implanted and removed, pacemaker inserted 2nd ablation procedure, watchman installed and will soon be off Xarelto,, I feel so much better I don’t know why I waited so long. Find a doc who will explain why, etc as it’s a process. If you want to make it to 80 it’s necessary to find a doc you trust.
Good luck in your search.

Why wouldn't take Amiodarone? I have been taking it for a year. I have a lot of dizzness

Amiodarone works well, but it carries risks. If nothing else works, and you don't want, or can't have, a pacemaker, then the drug of last resort is amiodarone. It has iodine in it, and over time, depending on the patient (always), it can become toxic to the body.

Essentially, if that is what you have been prescribed..................................you take it! Or, accept the consequences if they turn out badly for you. Nobody holds our feet to the fire.
https://www.drugs.com/tips/amiodarone-patient-tips#:~:text=Amiodarone%20should%20ONLY%20be%20used%20in%20the%20treatment,should%20be%20made%20to%20use%20alternative%20agents%20first.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756060/

Maybe you won't increase. There are outliers to everything in medicine. My brother by all rights should have died by ignoring his AF which led multiple pulmonary embolisms which he ignored until to the pain became in tolerable.