Connect
Should I get ablation treatment asap or when symptoms warrant?
I became aware of my irregular heartbeat Christmas 2023 after strapping on an Apple Watch I received as a gift. AF was confirmed by my PC doctor upon returning home two weeks later. I was referred to a cardiologist who confirmed the AF. As far as I can tell, I’m asymptomatic (I.e no fatigue, no shortness of breath, not tired, normal heart rate, etc). The cardiologist performed a conversion in March 2024 and the heart entered regular rhythm for five days before returning to AF. My heart has remained in AF since. I have been on 5mg Eliquis, 2Xday since January 2024 and continue my active lifestyle of walking and exercise. I’m an avid upland bird hunter and have not noticed any limitations in pursuit of this enjoyment, other than those attributed to getting older. I will be 72 in June. If I was to go forward with an ablation should I push to get it done sooner or when I start becoming symptomatic?.
Like
Helpful
HugInterested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.
Connect
Yes most definitely as you may damage your heart if you wait plus your needing to be young enough with good health to get the procedure done
I am also “on the fence” whether to get ablation or keep taking medication, my condition is paroxysmal supra ventricular tachycardia or PSVT for short. I advice you get well informed on the procedure paying attention to statistics, etc…, this should help you decide if you want to have the ablation done. Also I’ve heard and makes a lot of sense, that it’s important to have a EP ( electophysiologist) who has experience and a high rate of success. Hope this helps a little bit.
-
Like -
Helpful -
Hug
2 ReactionsWaiting regardless of being symptomatic or not brings its own risks. I don't know if you are lucky or not, not being asymptomatic. I myself am very symptomatic when in Afib. Lucky for me my Afib events didn't last long, a few days at most.
But in either case the heart is stressed when in Afib. It is not working correctly and blood flow is not normal and the beats are not normal. It also affects perfusion throughout the whole body and especially to the brain. And for me that is the reason to go for an ablation. It's the long term consequences of chronic Afib that I think warrants fixing it.
-
Like -
Helpful -
Hug
1 ReactionThis is my stock answer as recently replied to a PM (and keep in mind, it's my brain with my experience at work here; I don't mean to speak for all cases and for all people):
It's strictly your call. Obviously, I don't know a thing about you, and can't do more than to point out the possible outcomes of not controlling it better. If you're okay with that, then here is my counsel, which you must have seen in other replies to people by now:
a. AF is a progressive disorder. The more you have, the worse it gets. The worse it gets, the more problems will happen as it evolves;
b. Thirty eight percent of your time, your oxygenation is poor(er) than when your heart is in NSR. As you age, all sorts of things deteriorate. Now you're adding a deficit, even if mild, of oxygen to the mix;
c. Many people feel that, if it isn't so bad, or not the least bit intrusive, what's to worry about? I feel fine, and I have the two meds, sssoooooo........ That's good, but it isn't stopping the progression of your disordered heart toward more intractable forms of the arrhythmia, and it might go on to result in mitral valve fibrosis and prolapse, and it could end in 'heart failure';
d. Did your various blood tests happen to show any insufficiency of electrolytes, and how about troponin? If the electrolytes were lowish, and if troponin is higher than normal, you have options with the electrolytes (supplementation daily), and the troponin is a marker of myocyte death, probably due to the stresses of the arrhythmia on heart muscle;
e. An ablation, in the right hands, is now considered to be the 'gold standard' of care for AF. It has the best outcomes and the least morbidity between other options, including just controlling it with medication. Your burden suggests that, at the very least, you should be on an anti-arrhythmic drug (to be determined by a competent physician based on your genotype and phenotype), and if it were up to me, you'd be in line with an electrophysiologist now. The idea is to control the onset of AF, to prevent it, and to stay out of it for as much as is possible without making your life truly miserable. For me, being in AF was indeed truly miserable. It was bloody awful. So, soon after my diagnosis, and after reading about things like amiodarone, I knew an ablation was my goal. It took two rounds of it to work, which is the case for about 25% of all first-time ablatees, but I am three days away from my second anniversary completely free of AF. If you'd like to be where I am, you have two options....get on an anti-arrhythmic or get an ablation.
-
Like -
Helpful -
Hug
1 ReactionOne more comment…AF is a known cause of heart failure. AF can cause “remodeling” of the heart. Shape changes, thickness of the walls change. Once that begins it has a life of its own..and is also progressive.
I would not wait at all.
I’m just curious if after two years of being free of a fib following an ablation, are you still on anticoagulant medication? I too am 2+ years free of a fib after an ablation but my cardiologist continues to insist that I take 5 mg of Eliquis twice a day. I am currently questioning this as I have no other parameters indicating any heart problems. For example, I have low blood pressure, low resting heart rate good cholesterol level levels. So I’m just curious how many other cardiologist have you continue blood thinners when your symptom-free?
I personally do not agree that AF is a progressive disorder. I believe it probably is if you do not stop all the triggers.
I had it real bad for 7 years in my teens. It was due to bein EXTREMELY sensitive to caffeine. At 76, I was having minor incidents that were becoming more often. I read that heart problems can be due to insufficient water drinking. Most of my life, I drank very little. My mother didn't drink water either and had alzheimers real bad for 8 years. After reading that heart problems can be related to dehydration, I made a commitment to drink water. I began Jan 1st. They kept diminishing and have not had even short episodes in about one week. Before that lasted only a very few seconds.
If it was true that it is a progressive disorder, I would have been gone years ago. And they would have gotten worse even though I was drinking more water, but they haven't.
I think, and it's strictly my opinion, that you should indeed question the prescribing authority on this one. Ask him/her what metrics he/she is using to assign you such a risk of stroke that you should be on 5mg of Eliquis BID?
Just don't expect the answer you hope for. I challenged my GP as to why I still had to take a statin when my MIBI stress test, an MRI, an angiogram, and a carotid Doppler ultrasound, all showed that, even at the ripe old age of 68, and male to boot, they all showed minor deposition and nothing close to any blockage. He shrugged and replied, 'To help you live longer, you should take the statin.'
That's fine. Your story and experience matter, especially for you. But the literature says that it is a progressive disorder. I'll leave it at that.
To me that's like prescribing pain meds when you have no pain.
-
Like -
Helpful -
Hug
1 Reaction