PF ablation after one symptomatic Afib episode?

Posted by gavia2 @gavia2, Aug 24 11:48am

I’m scheduled for a PF ablation after only one symptomatic episode of Afib. I think that PF ablation as a first line treatment for paroxysmal afib is becoming more common, but I still can’t believe that it is necessary after only one event. Admittedly, I have felt flutters on and off for the past 4 years, but never anything that doctors or cardiologists could detect and no elevated HR. Any one else have advice?

More background. The symptomatic episode was in early June. HR spiked at 240. The life-flight medics converted it to SR with amiodarone. Multiple tests in hospital revealed no blockages or enlarged atrium or other concerns. I was on amio for 3 months, then on Eliquis for 1 month prior to the ablation which is scheduled for 2 wks from now. Then I’ll be on both Eliquis and amiodarone for 3 months. Then possibly no meds thereafter. I wish that were a guarantee. They’ll probably want me back on Eliquis after age 65 but I might refuse if age is the only risk factor at that point.

My EP is not communicative. Right now I’m fighting to get the results from my loop recorder which was installed in early May. As far as I know, I haven’t had another episode. I’m a scientist, so have tried to read the medical literature on pros and cons of ablation. It seems to be changing rapidly and it’s hard to figure out where I fall with respect to the average heart patient. I’m relatively young (63) and my heart and general health are good. Obviously, amiodarone is nasty stuff and they won’t keep me on it for more than another 3 months (thank goodness). EP says that I probably won’t do well with any other rate or rhythm meds because my HR is naturally low (resting was 53 before all this and is now 48). BP also runs somewhat low, currently around 110/60.

I worry about the serious complications of an ablation like stroke, death, and serious vascular injuries and the chance that the ablation itself will induce some other arrhythmia or heart issue (including causing need for a pacemaker, given my low HR already) that I probably would never get if left alone. I also don’t want a stroke caused by Afib! Very interesting that research has shown NO reduction in stroke after ablation!

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

lindy9 | @lindy9 | Aug 27 6:58pm

In reply to @windyshores "I wonder why doctors are treating me so differently. Not only am I on no meds..." + (show)

I think that the docs only prescribing meds other than as needed is a good thing. I wouldn't be envious of those who have been taking meds or treatments because from what I read here, many of them don't work. or they have problems with them. I would not envy someone having ablation after one episode. Continue to avoid triggers, and do not ASSume it will increase. Pray that it doesn't!

windyshores | @windyshores | Aug 27 8:51pm

In reply to @lindy9 "I think that the docs only prescribing meds other than as needed is a good thing...." + (show)

@lindy9 I am not envious. I just find the variation in advice to be curious, but it is typical in medicine and would seem to indicate a troubling lack of consensus.

I don't assume afib will increase. There is nothing special about me though.

I certainly continue to hope to stave it off as long as possible. My efforts to avoid triggers may or may not be contributing. Others work hard at it and still have trouble.

A doctor did prescribe meds for me initially and I respectfully declined after discussion.

Thanks for your good wishes.

jrccle | @jrccle | Aug 28 9:18am

I was first diagnosed with AFib when I was 59. I had no idea what it was and went to the hospital ER with trouble breathing and extreme tiredness. I was told that I had AFib, a left bundle branch block, and that my ejection fraction was 25%. I ended up in the hospital for 5 days so they could put me on Tikosyn. My cardiologist also prescribed Metoprolol, Atorvastatin, Xarelto, Spironolactone, and Diovan (before this, I was on no medication). For about three years, I had no problems and didn't make any significant lifestyle or habit changes. Then, towards the end of 2023, I started having AFib episodes with heart rates in the 180 bpm range. This repeated in early 2024. But then, in June 2024, when I got COVID for the first time, things went crazy. I ended up in the hospital ER three times in three weeks. During my first visit, I met an electrophysiologist who said it was time for a radiofrequency catheter ablation. The procedure was performed shortly after my third ER visit. In the past 13 months, I have been AFib-free. I got my sleep apnea treated and under control, reduced my alcohol consumption to typically no more than one drink a week, lost weight, and kept my blood pressure usually in the 110/70 range. About 6 months after my ablation, my ejection fraction was 60% (yay!). After 90 days, they took me off Tikosyn, but I still take everything else. I kind of wish I had had the ablation earlier, but I also know that skills and techniques have improved since 2017 when I was originally diagnosed. I hope that continues to be the case so that when I need my next one, the results are even better.

kfox21 | @kfox21 | Sep 1 11:05am

You might try a search as I did (attached). Recommendations are changing to ablation as first line of treatment.

windyshores | @windyshores | Sep 1 9:00pm

In reply to @kfox21 "You might try a search as I did (attached). Recommendations are changing to ablation as first..." + (show)

@kfox1 it says "for selected patients." Does the study define which patients?

bboeshore | @bboeshore | Sep 2 4:08pm

In reply to @windyshores "@lindy9 I am not envious. I just find the variation in advice to be curious, but..." + (show)

I was diagnosed at the VA in 2011 with PVCs by the lead cardiologist who put me on a treadmill and the heart monitor was next to me. As they speeded up the treadmill and raised the platform my heart reached 130 BPM and the PVCs went away. He pointed to the monitor as I was watching. His response: as you haven't had any symptoms prior and (We kill more patients than we help by putting them on medication - his words verbatim, we're not going to do anything right now. If you have trouble in the future please let me know.) I was subsequently passed to a young cardiologist who insisted I needed an ablation. I put him off. It is always important to research your diagnosis and get a second opinion or third. After reading about the possible complications, why, when experiencing no symptoms would anyone undergo an unnecessary procedure?

kfox21 | @kfox21 | Sep 2 5:29pm

In reply to @windyshores "@kfox1 it says "for selected patients." Does the study define which patients?" + (show)

Paroxysmal (intermittent)

windyshores | @windyshores | Sep 2 5:43pm

In reply to @kfox21 "Paroxysmal (intermittent)" + (show)

@kfox21 I think you misunderstood. It says

"for selected patients with symptomatic paroxysmal atrial fibrillation..."

What does "selected" mean? Were people accepted in the study with certain conditions or lack of conditions? Age? Gender? Length of episodes? Etc.

If it just said "for patients with symptomatic paroxysmal atrial fibrillation" that would be very different .

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