I have had lone wolf bagel tone related again for over 30 years now, I am 64. My first attack was quite severe with a sustained rate of over 230 for over 6 hours, for some reason they would not cardio convert me but injected Pronestol (?) in to my arteries and I was put on Procainnimide until I developed chemical induced lupus from it, took a year and four hospitalizations with multiple cardioconversions until they found Norpace CR really worked well for me when other drugs did not, but Pfizer is phasing Norpace out and my EP wants me off, tried Flexeril, right back in the hospital. Now they want to do an ablation and pacemaker even though I just had an outbreak requiring hospitalization first time in 5 years. But all they did was give me a blood thinner shot and put me on a monitor overnight for $10k, all my Docs on vacation so they sent me home and told me to lay low till I can see my EP in a month. Don't want to go the ablation route if it mandates a pacemaker, stuff always go wrong with me, have autonomic dysfunction as well. For example am allergic to iodine so they gave me the Predisone and Benadryl prep and it fried both my eye lens requiring surgery and then had complete victorious separation, both eyes post surgery. Any suggestions on how to discuss options with EP next month, thanks in advance...
Expanding on my last answer, here are the usual ways of dealing with chronic/persistent afib:
1. rate control ---- a beta (or calcium channel) blocker is prescribed to lower heart rate while in afib as well as an anticoagulant to prevent stroke (usually coumadin or aspirin). The patient lives the rest of their life with afib. Usually this is reserved for those who show very few symptoms. A large study (AFFIRM) a few years ago actually show that this method resulted in the lowest mortality and morbidity rates.
2.rhythm control --- a strong antiarrhythmic drug (e.g., amiodarone, sotolol, flecainide, rhythmol, etc.) is prescribed to maintain the patient in normal sinus rhythm. An anti-coagulant is also given. Occasionally, electrocardioversion is needed. At times (rarely), a pacemaker may be needed if the antiarrhythmic med used lowers the heart rate well below 60 bpm (bradycarida) giving symptoms of weakness and dizziness.
3. RF Ablation - usually the pulmonary veins are isolated resulting in a cure.
4. RF Ablation of the AV node and implantation of a pacemaker to pace the ventricles. The atria are left to fibrillate but the patient doesn't feel any of the afib symptoms. Coumadin is also prescribed to avoid clotting and stroke.
5. Implantation of a pacemaker designed to pace the atria out of afib -- not very effective. Sometimes used if the patient needs a pacemaker for other reasons.
6. Maze or mini-maze surgery. Surgery to electrically isolate parts of the atrium and so prevent afib. Maze involves open chest. Sometimes used in conjunction with valve surgery.
If a patient has only PAF (infrequent or occasional afib), the options vary from doing nothing to the first two options above.
Yes, this is one of the standard options for dealing with afib. It's appropriate for those who are highly symptomatic (unable to live their life normally because of chronic afib.. their heart races & they feel weak and dizzy) and have serious side-effects from rate or rhythm control meds and are otherwise poor candidates other types of ablation (e.g., pulmonary vein isolation). Usually, the patient also has other heart problems and a pacemaker might be indicated anyway. I have afib myself that's somewhat controlled by meds. But since I'm asymptomatic (absent serious symptoms) and have several med options, I would never consider such a drastic solution.
Has your friend talked to a good electrophysiologist (cardiologist specializing in arrhythmias) and ruled out alternative treatments? One shouldn't rush into this decision lightly. I'd even advise getting a second opinion.
Ablation for a-fib is not the same as ablation for SVT. A patient with SVT does not need a pacemaker implanted except in the rare instances that the AV node is accidentally ablated.