Medicine without ablation for SVT or AF

For me, it would matter what "manage" means to me. If you are symptom free and tolerate the meds without significant side effects, then I would say it is your choice. If you have sporatic outbreaks that are disruptive to your life or require ER intervention, then I would not be satisfied with that. I think it is entirely personal but the most current understanding of A-fib for me is that if it comes and goes, it is scaring and spreading and then it is more difficult to control. I wanted it treated with an ablation ASAP. Also, I am older and I didn't want the docs telling me that I was too old to get an ablation so I could just live with it. In the end, you have to do what is right for you. Good luck.

I agree fully with sjm46. As long as the burden is under about 8% of all beats in a measured 24 hour period, as long as it comes and goes on its own, and as long as the person isn't suffering unduly due to symptoms, then keeping a lid on AF and ectopy via calcium channel/beta blockers and probably a DOAC (direct-acting oral anti-coagulant) might be all you need. Or, you could experiment with propafenone, flecainide, Sotalol, or Multaq, as examples of anti-arrhythmia drugs if they help. But it must be kept in mind that AF is a progressive disorder. It will cascade through four stages in the majority of patients, each on more intractable than those previous. So, if you find that it is becoming more intrusive, less pleasant, or that your heart is showing evidence of 'remodelling' itself (atrial wall enlargement, possibly also with ventricular enlargement, mitral valve prolapse, collagen deposition in the myocardial substrate, and fibrosis showing up on MRI), the gold standard of care these days is catheter ablation, whether PFA or RF delivery. A successful ablation stops any progression attributed to remodelling, which will keep your heart healthier longer.

I have Afib and I have been on Toprol XL for 45 years and very few problems. No surgeries at all! But now 45 years later I am having problems of low HR in the 37-49 . I am seeing my Cardiologist now to determine why so low. BP is also fluctuating so I have been really satisfied with just the meds for this long!

@gloaming You are so knowledgeable! How can I become familiar with these types of parameters for how to treat arrhythmias? Right now I have a not-very -troublesome case of SVT but I know the situation for a 75-year-old goes beyond perceived symptoms. Can you point me toward the right learning experiences please?

@ccenj I'll try. I mostly read medical journals and research articles at the New England Journal of Medicine (NEJM) PubMed, Boston Medical Journal (BMJ), National Institutes of Health (NIH), The Lancet, or those published by the relevant organizations serving the cardiology/arrhythmia crowds. I also watch videos published by various entities where areas of interest to me are on YouTube. Dr. Scott Lee's 'AFib Education Center' channel on Youtube is a good one, but there are many others, and some will discuss other types of arrhythmia (I think there are 16!).
https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-supraventricular-tachycardia
https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-supraventricular-tachycardia
https://pubmed.ncbi.nlm.nih.gov/39838659/
https://journals.sagepub.com/doi/10.1177/03000605241238077
https://pubmed.ncbi.nlm.nih.gov/38497695/
This should be enough to get you started. From there, just use specific syntax in a google search, something like, 'treatment of SVT', or 'cardiomyopathy and SVT' and you should be pointed to lots of good information.

@gloaming. Thank you for that info .Having Watchman done next month and was on fence with Oblation . I have Proximal AFib and 71 yrs old going to research more .Had no clue about what Oblation was until recently.

@gloaming The info you shared is so informative thanks for helping us become more educated on AFib and.Arrhytmias …All new to me

I've had AF for about 5 years that was pretty much completely controlled with meds - Flecanaide and Diltiazem (+Eliquis) in my case. ...then it wasn't. I had an ablation (cryoablation to add to the PFA and RF methods mentioned by gloaming above) about 3 years ago, again completely controlling my A-fib without any meds. I then had mitral valve repair about a year and a half ago when my A-fib started up again. So far so good with no more A-fib; still on Diltiazem and Eliquis. 70 years old, coming up on 71.
All the best.

@gloaming Thank you very very much!!

Hello. I’ve been on bisoprolol and propafenone for SVT for 1 year and adjusting the dosages of both medications haven’t had anymore episodes. I consulted several cardiologists and I’ve been told that ablations have a 80 percent chance of working and that I might have to be on medication anyway, such a beta blocker which it’s ok if you also suffer of hypertension. So I opted to stay on meds. Hope this helps you.