Drugs vs Ablation for Atrial Fibrillation (AF)

Interesting video. I had my first heart racing episode on April 28th, it was 215 beats, paramedics said I was in SVT. Shortly after (an hour or so) they told me I switched to A-fib. I spent 2 nights in the hospital, my heart rate went to 88 or 104 somewhere between 8-12 hours later. I was on a heparin drip and beta blocker drip. At one point, they took me off the heparin drip for about 6 hours. I have spoken to two EP's and two cardiologist. My results on the echocardiogram, thyroid, lungs, heart xrays, nuclear stress test and wearing a heart monitor for 2 weeks, all came back with good to great results. So, I stopped taking Flecanide 50mg, 6 weeks ago, and went to once a day vs twice a day on Diltiazem 24 H ER (CD) per my EP. I see him on Sept 9th to decide if I stay on meds, continue to wean off the Diltiazem (I don't think they will let me go off Eliquis 5mg yet) or do an ablation. Since this is the first time ever for me, I am not sure I have an A-fib issue or SVT. The EP thinks it is A-fib, but does not know how long I was actually in it while in the hospital. I have had no episodes since April, some think I may have been dehydrated, so I am 50/50 on doing the ablation or just weaning off the drugs and see what happens. I have lost 14 pounds since the hospital (25 to go) and my annual cholesterol numbers came back the lowest they have been in 20 years, but my sugar went from 5.6 - 5.9 in 3 months? Doesn't make sense to me, eating better, had not drank alcohol for 2 months, my primary doctor told me it's age. I am 69 years old. Not fun stuff to think about daily....

@nanalu Be persistent! Keep trying to get in.

@nanalu You can find info on convergent ablations on YouTube. I have heard of it but did not investigate it at the time.

Thank you. I already checked it out. Seems like a process for persistent or constant Afib. I have Paroxysmal Afib but will ask my cardiologist about it

@sjm46
I will certainly try. Thanks for your encouragement.

This video is a bit dated, but here is an EP talking about what, at the time, was a fairly novel approach to AF treatment:

I have had 3 ablations. The last one August 2025. I had a lot of problems as my heart would not settle at all with afib and flutter( which I did not have prior). They put me on increased sotalol to 2 pills a day and added 2.5 mg 2x a day. it settled my heart but I felt pretty bad overal. At about 2months my heat went into afib very strong with a rate of 190 and BP at 75/45. It settled after 6 hours. 2 weeks later the same thing. They suggested an AV node ablation which made me very nervous so they suggested MULteque which has very bad side effects and I do react very strongly to medications. I was to go off Sotalol for 3 days prior to starting Multeque but stay on the Bisoprolol. I felt fantastic those 3 days and decided not to go on Multeque. 3 months later I am still feeling very good. I have episodes up to 3 % and mostly under 2%. I feel the ablation did help although my heart did react at first but the Sotalol was the main problem. I felt terrible the 1.5 years I was on it. I had to self diagnost in the end and I had a top electro cardiologist.

Dealing with Afib is certainly challenging. I have Paraxsysmal Afib and occasionally go into Atrial Tachycardia and Atrial Flutter. On occasion I need to go to the emergency room because my heart rate would go over 150. Needless to say, I would love for it to go away. Tried 2 Ablations but they didn't last very long. Plus for the last one, the Cardiologist still wanted me to continue with Multaq, 200 m twice a day. I have never been cardioverted because eventually I go back in Sinus rhythm. So to be so long winded, I have been on Multaq more than 10 years. 2 cardiologist told me it's less toxic than all the drugs out there to control Afib. Multaq is not appropriate for all types of Afib. Glad you are feeling better and hope you continue to do so.

awoke in afib 150-170, to ER, started on diltiazem drip x 4 hours with no results then amiodarone and heparin x 12 hours with not much improvement. Cardio version with good success. Home on eliquis 5mg bid and amiodarone 200mg bid. No cardiac history, 71 years old, no reoccurrence since return home 48 hours ago. Active 5 days/week, play pickleball, hike, daily walks. Weight within normal, 5'5, 120 lbs. Planned trip to Paris in 3 weeks, not sure if I will enjoy with increased anxiety. Your thoughts? Follow up with cardio team prior to trip.

@smwhit When I met my EP for the first time in anticipation of an ablation for AF, I told him that I had hoped to fly to Nova Scotia in a couple of weeks, and asked him those questions. He answered with a question, 'What would you do if you entered AF mid-flight?' I replied that I know to stay calm, and to try to relax and to breath deeply. Distracting myself with an in-flight video would probably work.' He shrugged and said that it was probably okay to fly. IOW, he was neutral, and we both knew that at 30K' ASL there wasn't much anyone can do. It's not a life-threatening disorder in almost every case, just an annoyance and it does raise anxiety. If anxiety is the worst of it, then you'll probably remain in AF until you settle at your destination.

It appears that you are paroxysmal, so it is self-limiting and very early in your formal diagnosis. That's a good place to be. If/when your disorder progresses, it will pass into persistent, long-standing persistent, and finally permanent AF, probably several years from now. It's not a lethal disorder. It won't kill you. You WILL want a cardioversion or a metoprolol bolus at the ER if it runs above 100 BPM for more than 24 hours, though. Your flight won't be anywhere near that long.

In case it's news to you at this stage, the gold standard of care for AF, certainly in its earliest stages, is catheter ablation. I would advise you to consult an EP before long if it begins to come on more persistently and last longer, say a day or two.