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Ablation or Cardioversion/Drugs first
The initial cardiologist suggested trying cardioversion before trying ablation to cure my artrial fibrilation. The surgeon seemed to think that with a 5 1/4 cm chamber that cardioversion woudln't work and my heart would just flip back into fibrilation. My question is - Is there any reason to NOT try the cardioversion and/or drugs first?  
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How long have you been in fib?  Is your atrial diameter that size due to hypertrophy from a long history of heart problems or is it just naturally large (mine is 5.7 with NO appreciable hypertrophy)?  Cardioversion COULD help.  Then again it might not.  It has the advantage of not being invasive.  I don't know about other folks but the only real negative to cardioversion (i.e. they stick two large electrodes to your chest and back and electrocute you) for me was the nice first degree burns I got from the combination of the current and the adhesive.  Yup a nice big burn on both my chest and back about 4" square.  

If cardioversion doesn't do the trick and you REALLY want to try to get out of fib, then the next step is ablation.  Unfortunately ablation is not so useful for atrial arrhythmias as it is for ventricular problems.  The odds on ablation are like this.  Initially it is about 3 to 2 in favor of ablation solving the problem.  If a single ablation doesn't fix your problem then the odds on a 2nd ablation working are dead even - a toss-up.  With an atrial diameter above 4 cm the odds in favor of fixing the problem start dropping. At an atrial diameter above 5cm the odds are significantly against ablation actually curing the A-Fib.  After that there is NO way to get out of fib unless your heart spontaneously decides to get its act together on its own.  The only way to get a regular VENTRICULAR rhythm at that point would be to ablate the AV node and pace your heart.  It works - just ask me and others here.

How irregular is your over-all rhythm?  Mine was all over the map from 30-odd to over 140 bpm.  It was described to me as irregularly irregular.  It changed from moment to moment with no discernable pattern.  Digitek and diltiazem kinda sorta kept me below 100 most of the time - kinda sorta.  

Whatever you do do not just blindly accept the word of any surgeon.  Cutters are great people but they believe in the supreme effecacy of "cryo-ferric" (cold steel) therapy.  I once had a cutter tell me that even when he didn't know exactly what was wrong the patients usually got better.  BRRRRR!  

How old are you?  What other symptoms are you having?  How much is being in fib throwing you off your game?  If the meds are keeping things more-or-less regular then you have to decide whether you want to proceed.  For me it was a no-brainer.  I was half alive.  I had to do something or crawl into a hole somewhere.  Ultimately it is your heart, your body and thus your decision and yours to live with the consequences of the decision.  

I am glad I had the AV node ablation and a pacemaker implanted.  I do not - I say again DO NOT - like being dependent on a machine to function.  But it beats the way I was living (if you couldreally call it living) before.  I'm ready to get on with my life.

Good luck.  Keep us posted.  If you want to talk privately, send me a private message.

Regards,
Bionic Bill
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