Isolated Atrial Fibrillation Episodes: Is Ablation a Good Fit?

There are scads of rate control and anti-arrhythmic medications. Bisoprolol, diltiazem, propranolol as examples of the former, and Tikosyn, Multaq, propafenone, and amiodarone, with the latter the AAR of absolutely last resort due to its inherent toxicity. I have no experience with any except amiodarone (long story), but was on it only seven weeks...thank God. I read that Tikosyn needs a hospital stay at startup, and also Sotalol.

The rationale for and against any of the interventions, medication or ablation, or even the drastic step of a pacemaker (usually means destroying the AV node, the SA node, or both), depends on age, other comorbidities, foreseeable interventions for other conditions, available support and monitoring, prognosis, and stage of life. Some can get by on self-regimented care without drugs, or with PIP (pill in pocket, usually a single dose of Flecainide). Others are so heavily symptomatic that they need relief or they'll be hospitalized ere long anyway due to anxiety and emotional distress, or for lashing out and getting the Law involved. Some can't/won't take any drugs whatsoever, for any reason, and they'll have a choice of pacemaker, living with it anyway, or getting the mechanical intervention which is catheter ablation. I chose ablation over medication even though the medication sort of took care of my symptoms and arrhythmia for about four years until things began to deteriorate quickly.

Many, many people are on Flecainide or something else. Why? Because it works. It's also almost always better than the alternative, which is to risk heart failure, atrial enlargement, mitral valve prolapse, and progression to more intractable forms of AF. In the event that Flec doesn't work, try another one. It might be the ticket.

No matter what, each of us is in the driver's seat. We elect to undergo or to forego as we choose. nobody in the cardiac world will hold our feet to the fire. They can assess us, and then recommend what they think is the best way forward. If one disagrees, then it's on them to live as they are wont.

The new ablation procedure is called Pulsed Field Ablation.
Im about to have my 4th ablation early 2025 and it will be Pulsed Field Ablation

PFA is currently only approved for a simple PVI, or pulmonary vein isolation. I am not an expert in this field, but it seems to me that, after three previous ablations, the area around your pulmonary veins should be well scarred. So, you may have another focus, or re-entrant, for the new signal, and it won't be in a place where PFA can be applied. Again, maybe I'm not up to date and it is now approved for other areas of the left atrium. Last I knew, it was only to be used at the pulmonary vein ostia, or where they empty into the left atrium's posterior wall. So I'm curious as to how your EP knows that he/she can use PFA....for a fourth application.

He is the head professor cardiologist at the hospital, he knows what he is doing.
He is the expert so I trust him and he is always looking after me.
There is no limit to how many ablations you can have, I've done alot of research myself.
Im listening to him before I listen to you
Thanks

Whoa! All I said was that I was curious as to how he knows he can do PFA...not that he is wrong. My intent was to elicit an answer, not to tell you that you were headed in the wrong direction, or that he is.

Keep your diagnosis to yourself, you don't know.

I'd like to remind members of the Community Guidelines (https://connect.mayoclinic.org/blog/about-connect/tab/community-guidelines/), in particular:

2. Remain respectful at all times.
- Exercise tolerance and respect toward other participants whose views may differ from your
own. Disagreements are fine, but mutual respect is a must.
- Personal attacks against members or health care providers are not acceptable. Such posts will
be removed.

@jay71, it seems as though there may have been a misunderstanding. I believe @gloaming's intent with their questioning was to educate not only the members, but themselves in regards to your provider's confidence in PFA. It is important to remain respectful as we all navigate difficult medical decisions, especially in written communication where intent is a tad more difficult to decipher.

@jay71, You mentioned your provider is a head cardiologist and is confident in their treatment decision. Has your cardiologist performed the PVA before and discussed how the procedure will work compared to other ablation's you've had?

I had a PFA on 12/9/24. In addition to PVI, the EP used it on the back wall of my left atrium where there was evidence of scarring from AFib.

@jay71 Good for you. There can sometimes be danger in groups like this when a person steps over the line making medical recommendations when they are not qualified to do so.