EP evaluation of persistent AFIB

Please read "The AFIB Cure" Also, remember to get the right doctor to do the ablation, it's as much an art as a science.
If you live near and can travel to Raleigh, NC, contact this office to send your test results, especially the latest echo, to the great cardiac surgeon, Dr. Byron Boulton; set up a consultation visit, perhaps by phone. He is Director of the WakeMed Structural Heart Program at WakeMed in Raleigh, NC. Phone (919) 231-6333. I had a serious regurgitation/mitral valve problem (caused by a gum/dental infection) and AFIB. He repaired my mitral valve, did an LAAC, and did an ablation to cure my AFIB. That was over three years ago. I am as fine as wine, off all meds too, except for 4 amoxicillin before dental visits. I am an 81-year-old male, just a kid.
Regards,
Sagan

Had an ablation still had a fib come back then I had another cardioversion and another cardioversion now they suggest another ablation so we’ll see what happens

@saganjames thank you for your input

@saganjames a surgeon did your ablation?

My concern is, having similar circumstances, that Afib begets Afib.
Also, in a very short time, my left atria went from mildly enlarged to 160 ml/ml2! Drs a reluctant to do any type of procedure with such a large atria.

My story is similar. Had no idea anything was wrong until my GP did my annual physical and detected it. I had one cardioversion that lasted 16 days. I was put on xeralto, metropolol and flecainide and hated how I felt. My doctor decided I could go for the ablation and I had one on September third. So far so good, I'm going to get a monitor in a couple of weeks for a week to see whats going on. He took me off the flecainide and hopefully the ablation was a success. Good luck.

AF is a progressive disorder for all but the very rarest of cases. It can be controlled well by lifestyle changes, sometimes quite drastic changes, while for others just losing weight, going off four cups of coffee each day, or foregoing alcohol are all it takes. Sometimes supplementing with elemental magnesium helps if one doesn't get enough of it in their diet.

Cardioversions are a literal crapshoot. They work well, one-and-done, for a lot of first time AF patients. Others, like me, get four of them over three years and they don't work for more than 20 minutes to 16 hours (yes, that's true). So, I got two ablations because the first failed. I'm in my 31st month free of AF after my second ablation.

This is exceedingly important: you do NOT want to submit your heart to an electrophysiologist (EP) who feels that he/she can only guesstimate a 50% probability of the ablation working. That's a TERRIBLE statistic. Across the field of electrophysiology, the standard claim is 75% probability of success, and the very best EPs get 80% on their first crack at you. So, about 25% of all index ablations fail across the field of electrophysiology. Gentleman doctors like Andrea Natale at Texas Cardiac Arrhythmia Institute in Austin and Dr. Pasquale Santangeli at Cleveland Clinic routinely get above 80% because they're well-trained and do 10-15 ablations each week. In Natale's case he travels to about six different hospitals in the western USA.

Please do get an ablation, but get it as early as you can while your heart can be treated the easiest....early in the AF game. Please shop around for a highly regarded EP, even if you have to travel, and even if you have to wait 4-6 months. You will be much further ahead to submit to the better experience of the best doctors.

Thanks for the input and information, I will reach out to the EP's you have mentioned.

@keepthebeat
A dental infection caused my heart valve problem which caused my afib. The terrific surgeon I had, repaired my heart valve, did the ablation, and also closed my left atrial appendage, a worrisome area for blood clots occurring. The plan was to get all three taken care of in one fell swoop. We are all different but that worked out very well in my case. Additionally, I'm not a doctor, but I've often wondered why closure of the left atrial appendage is not done along with every ablation, where the patient is a candidate for that particular closure. Just a thought.
Regards,
Sagan

@saganjames I see your point, and for me it would/should be protocol that all EPs discuss the ramifications of leaving the LAA open vs closed, not needing a DOAC if it checks out fully closed at the 6-month TEE mark, reducing the risk of stroke with an occluded LAA vs relying on a DOAC with its risk of serious bleeding, and so on. My hope is that this is done and that some opt not to have it (probably from being surprised with the topic's introduction as they sit there on their first visit not having done some homework about AF and it's associated issues, including the risk of leaving the LAA open). But, as a lifelong learner and educator, I try hard to remember all the pertinent and possible outcomes or potential problems with any action or intervention, and discussing the LAA's risks for AF sufferers would be high on the list. Why not a one 'n done approach while the body is on the slab right before them and open or otherwise catheterized, ready for the job(s)?