Drugs vs Ablation for Atrial Fibrillation (AF)

It is a personal decision with guidance from your doctors but I am a 71 year old women who has had afib or some sort of arrhythmia (flutter, or atrial tachycardia) since 2021. I have had four ablations, the last one was the new Pulse Field approach. None of them worked. I was put on Flecanade and had terrible side effects and didn't put me back in rhythm. I was on Sotalol for a while after my second ablation and it didn't keep me in sinus and the cardiologist admitted me and tried to raise the Sotalol level and my heart paused. He took me off of it completely. My sister who is 10 years older has also lived with afib for 20 years now. They put her on Tycosin and she had Torsades and it damaged her heard to the point where she needed a pacemaker and a defribulator. My cardiologist wanted to put me on this drug and I refused. The cardiac nurses say they see a lot of people with problems from that drug. I will not go on amiodarone either. It is a drug of last resort I am told. There are terrible side effects. My cardiologist recently wanted me to take Farxiga which I refuse to do because of the side effects and this drug was intended for people with Kidney disease and who are Diabetic. They discovered it impacted the heart and now are trying to use it for people with a 45-50% ejection fraction.

All in all, I take 25mg of metoprolol twice a day and eliquis and they added losartan to help my heart - not because I have high blood pressure. I live in and out of some arrhythmia but I feel well. I am not out of breath, I am able to exercise and do everything I need to do. I travel a lot but avoid high altitudes because I do feel it if I am exerting myself. Otherwise I, likey sister, have stopped trying to achieve sinus although sometimes I am in sinus rhythm. I no longer consume any alcohol, or caffeine or gluten to do away with triggers for afib.

I don't know if this helps you, but I believe many people live in afib - my oldest brother did as does my sister and others I know. It isn't the best option but I have found my body does not respond well to the drugs which don't change the afib anyway.

Good luck to you.

@loswalt0525 I am just curious; did the ablation ever stop the A-fib completely? What did the EP say about the reoccurence and when did it start after the ablation? I had to wait almost a year after my diagnosis to get an ablation and I, like you, did not want to take the anti-arrhythmia meds due to the side effects. I did use flecainide as a "pill in the pocket" a couple of times and that worked, but as far as taking a regular dose, I elected to not do that. My A-fib episodes were more sporatic than yours sound; I would have a two to four hour episode and then nothing for several weeks. I am almost one year after ablation and have not had any A-fib and only occasional awareness of PACs which my cardiologist says is no big deal. Have you made any lifestyle changes that are working. For me, giving up all alcohol (I was having a beer occasionally before) and cutting down on caffeine has helped, I think. I also lost some weight although I was not overweight to begin with. Just wondering how you will make out; please let us know.

@sjm46
Do you take blood thinners or no

@carlwgordon Yes, I take Eliquis and have taken it from the minute I was diagnosed with A-fib. My cardiologist, who I feel is very consciencious, practically ran out of the room to get a pill for me with a glass of water after he told me what I had. I had, a one point, tried to advocate for a lower dose, but he was adamant that this was not possible. I have taken it faithfully before and since my ablation. I have no interest in a Watchman procedure; I have no significant side effects from Eliquis (although if my insurance did not pay for it, I would probably be looking for a substitute since it is very costly) so I take it as directed. I have friends who have had mild to moderate strokes and I have no desire to increase my risk. I am consigned to taking blood thinners and if I can live A-fib free, I will tolerate the med.

@sjm46
Thanks I have afib if I run I can walk on treadmill up 3.9 mph. No problem. I am adverse to taking blood thinners.it may stupid but that what have decided so far. Thanks foe answering.

@carlwgordon I understand your hesitation but being able to exercise as you describe--I can and do walk the treadmill at 3.9 daily for 40 minutes and also the elliptical machine at level 8 for 35 minutes daily. This is great for you but it doesn't necessarily decrease the risk of stroke with A-fib. Do you take ASA? My brother has had an A-fib diagnosis for years and he took baby ASA until recently when he had a recurrence. I don't know how old you are but stroke risk is about the worst thing that comes with A-fib and I wouldn't downplay that at all. Have you discussed this with your cardiologist? It is, of course, your decision but a stroke can ruin your quality of life, even if it is a mild one. Good luck.

@sjm46
I will at end of September .I willni can carry a pill if an .episode. I hear some people are in a trail for use s pill when you have episode. At any rate I will have find out some sort of solution I feel comfortable with.

I'm 84 years old and have had a-fib for 12 years. Initially medication (diltiazem) was key to maintaining normal sinus rhythm. But after a few years I had an ablation which was effective for about 8 years. From the inception of a-fib I took the anticoagulant, Zarelto. At 81 years of age I had a GI bleed. I had to stop the anticoagulant and had a watchman placed. The difficulty that my cardiologist and I struggled with was the rapid heart rate. Between diltiazem, metoprolol and another I could maintain NSR for indeterminant lengths of time. The rapid heart rate always returned, anywhere from 5-80% of the time. Last week metoprolol was increased again which means I have to monitor my blood pressure closely. My heart rate is now between 110-130 about 60% of the time. When it drops to 85 I pray that it stays, but it never does. So on Thursday, September 3rd I am going to have a procedure, AV Node ablation. I am so worried and angry because this a-fib is so prevalent and defies a cure or solution. I think about what this ablation means. It will keep the atrium separate from the ventricles - no communication between the two chambers of the heart!!! I'm very frightened, but have been assured that it is the only way to go with a heart rate so high for most of the time.

@bforester1 I feel for you. I'm not in your boat (maybe 'yet'), but I would say your progression is not atypical, not by any means. I know people reading don't like to see me post this, but the stark fact is that most ablations have a limited lifetime. Remember, it's a progressive disorder once you have it. Maybe slow, maybe dead slow....but it progresses. So, while an ablation might last 8-10 years, I'd say you did very nicely. That first EP did a great job of buying you time out of AF, which would be the one condition that would hasten heart structural changes like enlargement and valve deterioration.

Your elevated HR is worrisome in that it imposes an unnatural burden on your heart that 'should' relax into a typical 50-58 BPM when asleep. Most adults who are otherwise healthy and active, even if advanced in age. Nuking your AV node prevents the irritable circuit that wants your ventricles to beat quite a bit more frequently than they need to....or should need to. If your ejection fraction (LVEF, in the left ventricle) is decent, then the high rate is a problem because it should be unnecessary. You're not climbing a long flight of stairs, so an HR running above 100 BPM is a distinct problem.

I'm guessing that you have a pacemaker ahead of you if they are going to destroy your AV node. Something now has to pace your two ventricles, and the AV node won't be able to do that any more.

I have AFib and taking Eliquis. Does anyone knows if Eliquis have side effects other than possible bleeding? I have been trying to research it but can't find a straight answer.