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DiscussionShould ablation be one’s first attempt at conversion of a fib?
Heart Rhythm Conditions | Last Active: Mar 22 3:15pm | Replies (10)Comment receiving replies

This is strictly my opinion from having read a ton of posts by patients, watched many videos by electrophysiologists, and from having done a lot of research and advanced reading:
If you are content with the way things are going, not suffering quality of life degradation, not losing sleep, and feel relatively secure with how things are being managed, there is no rush to jump onto an operating table in a cath lab. Your caregivers know that AF will not kill you. It can make you miserable, though, in which case it is your symptoms that matter most and that will be the reason your EP agrees to treat you. Of course, some patients' hearts do very poorly and they can go downhill quickly, so that would be another urgent reason for an intervention. Flutter cases, and cases of ventricular fibrillation would be more urgent than someone who is 'paroxysmal', where their arrhythmia comes and goes on its own accord, as yours does.
Further, most EPs and cardiologists would want you to attempt a cardioversion as a first step, especially when acute enough that you called an ambulance and were taken to the ER, or if you went their on your own. Cardioversions work for some, even sticking for many months or forever afterwards, whereas people like me were a bust...none of them lasted more than 16 hours (I have had four spread over two years).
Amiodarone, when I googled it three years ago with that very syntax 'is amiodarone the drug of last resort', the answer was immediate and positive. Even so, I had to be placed on it for eight weeks in total after my first ablation failed and I ended up in the ER with an erratic heart. I went off it, was happy until the Holter monitor at 10 weeks post ablation, and then learned the Holter had detected many PACs. From there, with yet another bout of AF over the New Years, and sending a Galaxy watch ECG to him, my EP agreed to try another ablation. I have been free from AF for just over two years now. But, to return to amiodarone, it's not everyone's fave until you really need it, and then it's your best bud. It worked for me, and I knew it was meant only to stabilize me and to get me to the Holter at 10 weeks out. I was advised to go off it about two weeks prior to the Holter so that the Holter got me a pretty accurate picture of my heart's state of disorder....which was unfortunately still quite wonky.
This is getting long...sorry...I do go on...but I would not agree to amiodarone unless I was highly unstable, under great emotional and cardiac duress, and could not be ablated any time soon. To me, a cardioversion should be tried first, then flecainide or some other anti-arrhythmic that fits your circumstances well (they're not all the same chemically). I don't feel there's a rush to an ablation. Once again, it's the patient, in concert with the physician, who negotiates what happens next with 'the system'. You should NOT dismiss the cardiologist's or EP's advice, certainly not on my account...or on my opinion..., and you will ultimately need that person in your corner, so-to-speak, so be careful pushing them away from you. You want an ally, and in this case, a highly skilled and friendly ally. If you'd like more time to think and to research, why not ask for that consideration in so many words? Ask if you can pose three or four telling questions to help you to figure out your way ahead. And then, stick to it, and go for it. As I said, I have had two ablations, no regrets whatsoever. Some, whose EP was unsuccessful for whatever reason, say they do regret it. If you get the best EP around, ideally someone who has already performed several thousand ablations (IOW likely to be in his late 40's or early 50's), your odds of success rise measurably. My EP was frank and up front, and told me in our first meeting that his success rate was running at 75% for an 'index', or first, ablation. I knew I could trust him right away. It took him two tries, but he got 'er done.
Replies to "This is strictly my opinion from having read a ton of posts by patients, watched many..."
Thanks so much for your input. I appreciate it and I’m reading and probably will have more comments later.
Thanks again