Isolated Atrial Fibrillation Episodes: Is Ablation a Good Fit?

You have every right to worry. We all handle our stress different ways. I don't worry until the night before and the morning of the procedure. Other people have a sense of dread when they are in Afib. They will give you detailed descriptions on how awful they feel. And they have a right to feel that way. I wouldn't tell someone to suck it up. We all handle pressure differently and the last thing I believe you do not need is some one telling all the reasons not to worry. This is hard to go through. And needless to say if your family is not available it is harder without your support system. These feeling are natural and not necessarily negative. They are what the are.
We are humans after all. What might be good is to remember is that you are doing this to increase the quality of your life as well as your life expectancy. These are the important issues to remember. You are taking care of yourself and that is a good thing. Many have gone before you and many will come after you. What is good is that modern technology has improved greatly in the last decade improving outcomes for many people. Expect to feel lousy when first waking up and that is normal. You might have some sensation in you chest because they have been working in there trying to fix your rhythm. But heal well and take every moment as it comes with as much good wishes and thoughts you can give to yourself as you can muster. Take care of yourself and I wish you the best. Good for you.

I don't know what this person read, but I do keep up with the latest and greatest on all things ablation....to the extent a layman with an aging mind can. Every video I have watched that is less than a year old, and I have seen at least six in the past week (ya gotta trust me on this; I'm keenly interested!) says that ablation is INCREASINGLY THE gold standard for treatment, and the reason is because morbidity is greatly reduced across other forms of intervention. In fact, the latest research has lowered the upper limit for 'burden', that being the amount of time the heart spends in tachyarrhythmias or in dysrhythmia. It used to be 8%, but an article I saw before Christmas said it was better to start treating more aggressively when the burden rises past 3%.

Once your friend challenges his current cardiologist to learn of his/her rationale, he would be strongly advised to seek at least one more opinion. Please do call...today....and get an appointment, in office, with a good, well-regarded cardiologist, even if you have to drive him for an hour; it will be worth it.

Thank you so much, I have really enjoyed reading and re-reading your input. I appreciate your references to John Mandrola and the Skeptical Cardiologist. These sound like very practical resources. I took a look at the professional society journal I thought could be helpful - they have open access. BUT, I see these articles are highly technical, and above the level I could easily understand or that I need to reach for. I have obtained alternate literature from my medical librarian friend, although I haven't read a bit of it yet; the flu really has me off my game. Anyway, the literature won't take the place of real-life patient experience shared by you, @gloaming and others who are contributing here.

I’m so sorry that you have the flu. I heard that it’s a real kicker this year. I hope you recover quickly and feel much better soon.

The Skeptical Cardiologist (Anthony Pearson MD) has a newsletter that I think you can still sign up to read even though he also publishes it on Substack where everyone seems to be going to these days. All the writers offer much of their information in their free subscriptions but there are options for paid subscriptions as well which gets you more. I just opt for the free versions or I would quickly go broke. I also only subscribe to a few people or I would spend all day reading about everything under the sun on Substack, much of what is just someone’s opinion about anything with the author’s hoping for a following and/or a few bucks. Pardon my skepticism, smile.

I worked for a health services research company (Altarum) for the last 18 years of my working life and had access to excellent information albeit much of it over my head. I pulled data for studies for analysts. So I miss having that ability to get the latest and greatest. Mandrola and Pearson do write at a level one can understand. Mandrola and the “Sensible Medicine” team of Vinay Prasad (a maverick - Onocologist), Mandrola (cardiology/electrophysiology) and Adam Cafu (Internest) post really interesting subjects on Substack.
Cifu can get very technical and I swear he is interested in all aspects of medicine. I never know what he will post next. He has an incredible mind.

We’re all a data point of one. What I like about the three physicians above is that they seem to recognize this and still appreciate tailoring processes to the patient. They all feel that the healthcare system needs fixing and agree that there’s too much medicalization these days with the “pre’s:” Pre-diabetes, Pre-heart disease with Pharma anxious to treat people in said Pre-XXX with medication. Well of course! I’m old enough to remember when the upper level of normal fasting blood sugar was 115. Working for a health services research company, we were offered yearly lipid and fasting blood sugar tests and if we came in okay, along with waist measurement and within a reasonable weight, they put money into our HSA’s. You had to ace 3 out of 5 to get the money. The year that they changed the fasting blood sugar normal limit to under 100, I lost that point every single year as my ‘normal’ fasting blood sugar ranges from 101-105. Then when they developed the A1c test to see if you are diabetic or pre-diabetic, I always scored high pre-diabetic. But when I test myself as if I was diabetic with 4 to 5 finger pricks a day that sends the reading to an app that will spit out a report, I can’t even get to pre-diabetes. Turns out that not all A1c tests are standardized and after spending a year and a half with a diabetes doctor, he finally tested my A1c in his office and it was normal. Six months later he tested again and again I was normal and was dismissed as “cured.” Every year, even though I tell whatever doctor I have (we have high doctor turnover where I live) that I test high in A1c which is proven wrong with finger sticks, I still end up finger sticking for 2 weeks after that yearly test and sending the app report to them that clearly says on it “no manual entries” and shows that aside from my fasting glucose # typically at 101-105 with an occasional 99, every single finger prick shows that I’m in the green range.

We have to advocate for ourselves. I’m the one who asked the diabetes doc if I could test myself as if I was diabetic to find out what I was eating that created a high A1c so that I could try lifestyle change first. And look what we discovered! Dr. Ruiz who initially wanted to put me on Metformin, expressed dismay that if he had, my blood sugar could have dropped too low and caused me some serious problems.

I’m not against medication when it will help me. Obviously I’ve been taking the extended release beta blocker and BP med for years. But I’m wary about having unnecessary tests and unnecessary medications prescribed so I ask for time and more discussion before submitting to either so that I can learn more about them from resources and sources that I trust.

Keep your inquiring mind and pay attention to your body’s signals, to the information you can find and hopefully to a good informed discussion with your doctor(s). Doctors are so overloaded these days I know it can be hard for them to pay deep attention to their patients. Some try harder than others but some choose the cookie cutter approach and something that will tick the box on their EMR that shows that they offered a solution or prescribed a known course of action. They are also judged by what they put on their EMR’s. If you have access to a patient portal and can read their visit notes you will probably discover lots of things they said they discussed that was never discussed. I’m always amazed at how many things are in my chart that if I hadn’t looked at it, would never know what I still don’t know despite it saying something contrary in black and white. Good thing that I have a sense of humor.

A last example is my colonoscopy this month. Doctor came to my bedside after the colonoscopy saying that 3 small polyps were removed and that I should come back for another colonoscopy in 3 to 5 years because I am healthy. ??? - if not healthy I guess it doesn’t matter???

The next day I get a copy of my pathology report and it says to come back in 5 years given my mother had colon cancer.

I then get the official letter from the doctor who did the colonoscopy saying that the pathology report showed no cancer so I should come back in 7 years except that I’ll be 75 in a year when colonoscopies are no longer recommended so I don’t have to have another colonoscopy unless I want to have one.

At least I have options, eh?

Sorry for such a long answer that strayed from Afib and ablations and into the confusing world of figuring out how to best manage our health with so much conflicting information out there. Mandrola is an excellent source, and once again, I hope that you feel better very soon!

There is a new(?) different(?) modified (?) enhanced (?) approach to the former ablation approach researched for years if I am correct that is now used in several if not many major health facilities. Words used to describe it are "safer" and "faster" for example. I would suggest you access web sites of some of the major heath centers with teaching hospitals with the term "ablation" . That should be addressed with some if not all. That may be what your friend was referencing.

I cannot find any peer reviewed articles in the NIH data base that even remotely suggests that ablations are a a problem. All the latest data comes up when searching Afib +Ablation. In fact I found numerous articles that also say Ablations are more effective and more economical than medicine control of Afib. As for my experience my doc did a 2nd ablation (5 1/2 years after the 1st) on me after I began experiencing regular Afib events on average every 4 weeks for almost a year. My burden was at or below 1% for all those events. I always self converted between 18 hours to at most 3 days. His reasoning was I was having multiple Afib events and even though my burden was low I was obviously heading towards more failures and possible higher burdens. The earlier the better to catch it.

Ablations.
First after an ECHO, ECG and Heart Monitor you are assessed re your heart's structural situation. If the latter has a problem you cannot have an ablation.
Then weight, age and whether you are already in persistent AF and length of time are considered.
An ablation scars the heart so part of your heart is affected for life.
There's no going back.
There are risks assoxiated with an ablation too. There is radiation involved. The surgeon involved needs to be behind a glass screen or wear a heavy apron.
I've noticed that after these procedures, the heart responses by low BP and H/Rate. Then its a pacemaker etc.
Many need another ablation because it did not work.
Look up Radckiffe Research you can watch the procedures on their website and particularly is you have some sort of medical job. Even as a volunteer.
I'm one who was diagnosed as RAPID and Persistent AF and the medical staff don't even try to change the rh.ythm. That is what ablation is all about changing the rhymn vack to normal beat.
But my effective med CCB Calcium Channel Blocker acts as a safe anti-arrthymic med by slowing down the H/Rate.
On introduction it was too high as within 2 hours took my H/Rate from 156 (on 5mg Boisoprolol 156 to 51. I eas introduced to 180mg Diltiazem CD.
Changed within days to 120mg CD AM I've been on this 3 years and the Bisoprolol has been stopped as my BP has gone low.
I also cope with keeping my Thyroid TSH @ 1.7 as I take Synthroid (Thyroxine) due to a thyroidectomy plus in 2020 for papillary Cancer.
It was in facr the cancer that caused the AF which caused a embollic stroke in 2019. Diagnosed with all three in hospital within 4 days.
I read that they are pushing folks into ablations. There are a few to choose from.
cheri JOY. (Tuckie)

Hi Celia,
This is in reply to your question about whether or not A-fib might show up on a blood pressure monitor if you were having an episode while you were taking your blood pressure.

The short answer is that you won't get notification of "possible A-fib" like you would with a Kardia mobile or a Smart Watch, but you might well get some indication of an irregular heart rate. Many of the blood pressure machines ( the one I'm most familiar with is the Omron series) have irregular heart rate indicators, look sort of like multiple hearts overlapping each other. These irregular heart rate indicators are displayed if the heart beat intervals differ from each other for two or more of the heart beats while the blood pressure is being taken. It doesn't indicate what type of an arrhythmia is going on, just an irregular rhythm going on.

The heart rate is also displayed, if tachycardia is shown ( more than 100 BPM) that could be an indication of some type of an arrhythmia, although A-fib can also occur in the normal BPM range.

I haven't had this happen recently, thank goodness, but in the past before my cardiac electrical issues were diagnosed and controlled, my tachyarrhythmias would be so bad that I wouldn't be able to get a blood pressure reading at all, in those cases I'd just get error messages, but no reading. Sometimes when that happens you can repeat the blood pressure and you might get a reading the second time, or at a later time.

Thank-you. While ablations might seem to fall into the 'dollars earned' darling of cardiac arrhythmia treatment, and yes they are invasive, and yes they bring risk (as any invasive procedure will), the data is firming and it shows that an ablation will free more people from arrhythmia more completely and for longer periods of time than do just the drugs. What I have not seen stated explicitly is that, if an ablation is 'successful' (meaning free from arrhythmia for one full year), the patient needn't take drugs during that time. Further, the heart can't get used to, or find pathways and re-entrants around those drugs, if it ain't being exposed to them! What this means is, if a future ablation isn't in the cards for a given patient for some reason, and they develop recurring AF, at least he/she can be pointed to potentially efficacious drugs once again and start that battle all over again.

The A1C thing - very clever of you to get that sorted out. Very entertaining story, too. As for the colonoscopy story, too bad there's no laugh emoji. As you say, at least you have options, cause who doesn't want to have as many colonoscopies as they can fit into their lifespan? I signed up for Mandrola and Pearson's posts. Anyway, I'll see my EP tomorrow and we will discuss pill-in-pocket anticoagulation and rhythm management in paroxysmal AF.