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Drugs vs Ablation for Atrial Fibrillation (AF)
Those trying to make up their minds to get an ablation or to commence, or stay one, a regimen of anti-arrhythmic medicines might be interested in new evidence:
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This is a really excellent video which I had not seen previously. It supports everything that I have learned and believe about treatment of A-fib since I was diagnosed. My EP's APRN told me that the use of ablation (pulse field is what I insisted on) has advanced in technical efficiency in just the last few months. What this video doesn't stress enough is that when a patient is diagnosed with A-fib, the cardiologists (and mine is excellent) do not offer the options from the very beginning when a patient is in the paroxysmal stage. The first thing I got was an anti-coagulant and medication for rhythm control. Then I had to wait for 4 weeks to get a cardioversion that was only successful for rhythm control for about 5 months. Only when I did the research online did I learn about and decide that ablation was the way to go. I had to ask for, insist on, getting a really excellent EP and pulse field type ablation. I would have driven miles to get what I wanted. Fortunately I had an exceptional doctor who I think did a thorough job (not just a "cookie cutter" ablation which is what I have heard some less experienced EPs do). This is the most definitive video I have seen reaffirming that treating A-fib early is the best chance at successful treatment; I think I have a very good chance of staying in rhythm for a long time--it's been 9 months and I have had no episodes and am on a fraction of the B/P med that I was on before. This video could have also mentioned lifestyle changes, which I believe are also important. Losing a little weight (I was never overweight) with daily exercise and avoiding alcohol also helps. Thank you for posting this; I think everyone with A-fib newly diagnosed should see this. BTW: I was 78 when I was diagnosed and was worried that my age would eliminate me from being considered for an ablation, but that was not the case.
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4 Reactions@sjm46 ,
Good that the ablation worked for you. I was 79 when Afib presented itself as persistent. I have Apical Hypertrophic Cardiomyopathy and see a genetic cardiologist in the HCM clinic at the Mayo in Rochester. He said I had to hve been having episodes when I thought I was having palpatations (which never showed on my holter). He referred me to the Heart Rhythm Clinic and the EP I saw gave me all the options and the pros and cons. When I asked what he would recommend, he said he would start with an antiarrhythmic medication. So, I have been taking dofetilide (Tikosyn) for 3 years and worked great for 10 months and then I had occasional breakthroughs that would self convert. When they started to become more frequent, my HCM cardiologist added Jardiance to "fine tune the diastolic dysfunction" caused by the ApHcm. Now I have been afib free for a year. I realize an ablation is the best if done early and think I was headed that way when I was having episodes, but the ApHcm is an additional risk factor as I have a pouch (not quite big enough for aneurysm) on the apex of my left ventricle. So, I am hoping to avoid an ablation, but might happen in the future. Good luck and I hope you remain Afib free.
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1 Reaction@sjm46 It is unfortunate, in some ways, that cardiologists make a living from diagnosing, informing, consulting, and then prescribing for patients because referring their patients right away for an ablation cuts them off of the potential income. IOW, it isn't in their interest to send a patient of theirs out the door, pointed toward the EP's offices across the street. So, as you say, they tend to want to keep you in their offices for at least a year or two.
Call me cynical, but.......................all EPs are cardiologists before they specialize. Why go to the Middle Man?
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1 Reaction@sjm46 Second reply to you, this time about age. My well-ripened dad, who was 95 when this happened, told an attending at our local ER that, due to his age, he was told previously, or had read, that undergoing general anesthesia was ill-advised and not normally done. BS, said the internist.
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2 Reactions@emo44 I hear you; it is clearly a personal choice and everyone has to do what is right for them, especially if you have additional physical issues to consider. My cardiologist told me the same thing when I asked him why he didn't send me to an EP in the first place; he said that many folks are terrified of having any procedure that involves entry into the heart or general anesthesia. If the A-fib was persistent when you were diagnosed, you could already have a more extensive areas of triggering that would require a more extensive ablation technique, or more than one ablation as the video suggests. So I hope you are able to control your episodes with meds. I also realize that some people see our age as a critical factor--"like how many more years do I have anyway? I'll just live with it." 🙂 Everyone is different. For me, I just wanted to live in peace if possible with a good quality of life. I still wonder if it will last, but according to the statistics, I have a pretty good chance of living with NSR. Fingers crossed. I wish you good luck, but don't let age make your decision. We could be around when the world gets back to normal! LOL
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2 Reactions@sjm46
So you had to remain on blood thinners after abilation?
@sjm46
My cardiologist actually sent me to an EP right away when my Afib started. Unfortunately, another negative for an ablation for me is the fact that it almost always takes two or three procedures when you have ApHcm due to the wall thickness of the left ventricle. Therefore, I decided medication was a good first choice. And, I didn't really consider my age in my decision. I am physically active, walk severaly miles every day and also exercise. My decision was more based on not wanting to have two or three ablations before it worked. Hopefully we will both still be around when the world gets back to normal.
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1 Reaction@carlwgordon Normally yes. There is such a thing as a 'CHA2DS2-VASc' calculator which you can easily find online by those letters and numbers in quotes. Enter your data honestly and see what your score is. If it's 2.0 and higher your advisor will want you on an anti-coagulant for life, or until a repair of a nature happens that it no longer makes sense to take it. They're called 'DOACs' incidentally....direct-acting oral anti-coagulants. Like Eliquis (apixaban), or rivaroxaban (Xarelto).
If we're talking about atrial fibrillation, the risk of a stroke rises 5 times after about two hours of fibrillation. That hour figure varies a bit on the source....some go as high as 12 hours. !! After an ablation, with inflamed endothelium in the left atrium, there is even more of a risk of a stroke....so you must continue a DOAC for at least the blanking period of 10-12 weeks. Even then, until it is confirmed you have no more obvious AF, but no Watchman implanted, your advisor would still insist on continuing a DOAC. If you have a Watchman installed, and a confirmatory TEE shows no leakage out of the Watchman, then if all other health indicators are good for your body, most EPs will agree to stop the DOAC. Not all, and it does depend on what else is....ummm.....falling apart on or in you. 😀
@emo44 I think your reasoning is sensible, but...and I do not know anything about your condition (I am an AF patient)...if your condition tends to be progressive, or evolutionary, in nature from patient-to-patient, you might want to include in your calculus how less likely an ablation is going to be the further you go along your path. IOW, is now the best time to at least try one ablation, maybe two if needs be, or will you still be a pretty solid try in three years?
@gloaming
Thanks for replying